title: Beneficial effect of low-dose systemic retinoid in combination with topical tretinoin for the treatment and prophylaxis of premalignant and malignant skin lesions in renal transplant recipients.
abstract: Renal transplant recipients experience a greatly increased frequency of neoplastic skin lesions, including aggressive squamous cell carcinomas. Recent reports suggest that high doses of systemic retinoids may exert a chemotherapeutic and chemoprophylactic effect. Similarly, topical retinoid, especially tretinoin, has also been shown to be anti-tumoragenic in various settings. Because of the serious toxicity of high-dose systemic retinoid, a protocol was developed that combined topical tretinoin with low-dose etretinate (10 mg daily) for the treatment of frequently occurring dysplastic skin lesions in renal transplant recipients. Seven patients elected to receive combined tretinoin and etretinate therapy, and 4 were treated with tretinoin alone. Clinical evaluations were performed monthly. By 3 months of therapy, 9 of 11 patients exhibited at least a 25% decrease in the number of neoplastic growths. After 6 months, 6 of 8 evaluable patients, including 2 of 3 individuals receiving tretinoin alone, exhibited at least a 50% decrease. Three of 4 patients on the combined regimen and 2 of 3 receiving tretinoin alone for at least 9 months, exhibited a significant decrease in the rate of development of new squamous cell cancers. At the start of treatment, epidermal specimens were almost completely devoid of Langerhans cells (CD1+ cells). Their density increased greatly and in proportion to the duration of therapy. Long term topical tretinoin with or without low-dose oral etretinate seems to be an effective regimen to suppress the development of new tumors and to reduce the numbers of existing lesions in renal transplant recipients.
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia 19104.
authors.forename: A H
authors.initials: AH
authors.lastname: Rook
authors.forename: C
authors.initials: C
authors.lastname: Jaworsky
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.forename: R A
authors.initials: RA
authors.lastname: Grossman
authors.forename: J T
authors.initials: JT
authors.lastname: Wolfe
authors.forename: W K
authors.initials: WK
authors.lastname: Witmer
authors.forename: A M
authors.initials: AM
authors.lastname: Kligman
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005050:Etretinate / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007150:Immunohistochemistry; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D014212:Tretinoin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014212:Tretinoin; D005050:Etretinate