title: [Sirolimus-induced onychopathy in renal transplant recipients].
abstract: BACKGROUND
  A large number of drugs may be responsible for the development of nail changes. Sirolimus is an immunosuppressive drug recently developed in organ transplantation. Herein, we evaluate sirolimus-induced nail abnormalities in renal transplant recipients.
  
  
  METHODS
  The nails of 80 consecutive renal transplant recipients receiving sirolimus have been evaluated in a systematic dermatological study in 2003. The patients were mainly men (60%) with a mean age of 48 years. The mean duration of the graft was 6 years and of sirolimus treatment 18 months. Mycophenolate mofetil and steroids were combined with sirolimus in 86% of patients.
  
  
  RESULTS
  Fifty-seven patients (74%) complained for nail alterations. The most frequent anomalies (88%) were matrix alterations including slow growth, onychomalacia, onychorrexis, and leukonychia. Nail bed alterations (onycholysis), vascular phenomenon (erythema, splinter hemorrhages), and periungual anomalies (mainly pyogenic granulomas) were observed in 42, 42 and 19% of cases respectively. One observation of type 1 photo-onycholysis was described.
  
  
  CONCLUSIONS
  This study reports a new drug-induced onychopathy. Responsibility of sirolimus is highly suggested. The main pathogenesis hypothesis to explain these nail alterations is inhibition of EGF (epidermal growth factor) pathway by sirolimus.
authors.affiliation: Service de Dermatologie, Hôpital Necker-Enfants Malades APHP, Paris. emmanuel.mahe@apr.aphp.fr
authors.forename: E
authors.initials: E
authors.lastname: Mahé
authors.forename: E
authors.initials: E
authors.lastname: Morelon
authors.forename: S
authors.initials: S
authors.lastname: Lechaton
authors.forename: H
authors.initials: H
authors.lastname: Kreis
authors.forename: Y
authors.initials: Y
authors.lastname: De Prost
authors.forename: C
authors.initials: C
authors.lastname: Bodemer
mesh_terms: D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000139:chemically induced*; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus