title: Skin infections in renal transplant recipients and the relation with solar ultraviolet radiation.
abstract: BACKGROUND
  Ultraviolet radiation (UVR) is an important risk factor for skin cancer in transplant recipients. In view of the potential suppressive effect of UVR on host resistance it was examined whether exposure to UVR was also associated with the occurrence of various skin infections.
  
  
  METHODS
  In a cohort of renal transplant recipients (n = 137), lifetime exposure was assessed by means of a retrospective questionnaire on cumulative sunlight exposure. Diagnosed skin infections since renal transplantation were extracted from the patient's medical charts. Season of diagnosis was regarded as indicative of short-term exposure.
  
  
  RESULTS
  In comparison with winter a high rate of herpes simplex infections was found in spring [rate ratio (RR) = 4.09, 95% confidence interval (CI) 1.2-14.5], and high rates of herpes zoster infections (RR = 1.6, 95% CI: 0.8-3.5) and fungal/yeast infections in summer (RR = 2.1, 95% CI: 1.3-3.4). A higher lifetime exposure (RR = 2.31, 95% CI: 1.04-5.1) and a greater cumulative number of reported sunburns (RR = 2.3, 95% CI: 1.1-5.1) were independently associated with a higher risk of bacterial infections.
  
  
  CONCLUSIONS
  The seasonal association with the occurrence of clinical herpes infections indicates an effect of short-term UVR. Our data suggest that the number of sunburn episodes in the past is also relevant for the susceptibility to certain skin infections.
authors.affiliation: Laboratory for Toxicology, Pathology and Genetics, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Termorshuizen
authors.forename: A A
authors.initials: AA
authors.lastname: Hogewoning
authors.forename: J N
authors.initials: JN
authors.lastname: Bouwes Bavinck
authors.forename: W G
authors.initials: WG
authors.lastname: Goettsch
authors.forename: J W
authors.initials: JW
authors.lastname: de Fijter
authors.forename: H
authors.initials: H
authors.lastname: van Loveren
mesh_terms: D002179:Candidiasis, Cutaneous / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003881:Dermatomycoses / Q000453:epidemiology / Q000209:etiology; D006561:Herpes Simplex / Q000453:epidemiology / Q000209:etiology; D006562:Herpes Zoster / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000209:etiology; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000209:etiology*; D013471:Sunburn / Q000150:complications*; D013472:Sunlight / Q000009:adverse effects*