Use of Topical and Systemic Retinoids in Solid Organ Transplant Recipients: Update and Review of the Current Literature

Abstract

BACKGROUND Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy. OBJECTIVE To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs. MATERIALS AND METHODS Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population. RESULTS Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients. CONCLUSION Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.

Isotretinoin and the eye: A review for the dermatologist

“…Other uses include hidradenitis suppurativa, scarring alopecia, viral warts, cutaneous lupus, and photo-aging. 13,14…”

“…Solid evidence favored the use of isotretinoin in rosacea, sebaceous gland pathology such as seborrheic dermatitis and sebaceous hyperplasia, and as prophylaxis of non‐melanoma skin cancer. Other uses include hidradenitis suppurativa, scarring alopecia, viral warts, cutaneous lupus, and photo‐aging 13,14 …”

Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

“… Oral retinoids in selected cases. Acitretin has the most robust evidence for chemoprophylaxis of NMSC and treatment and prophylaxis of AK in solid organ transplant recipients (Grade A recommendation) [ 47 ]. The evidence in the general population is low.…”

Retinoids in Cutaneous Squamous Cell Carcinoma

“…However, cSCC can also form from papilloma virus (PV) infection [2,3]. Precancerous lesions include warts, actinic keratosis (AK), keratoacanthomas (KA), and porokeratosis [4]. While cSCC is seen in the upper cells of the epidermis, this cancer originates from aberrant regulation of hair follicle stem cells [5][6][7][8].…”

“…Skin also contains a unique retinoid: 3,4-didehydroretinol (ddRetinol), with its corresponding ester (ddretinyl ester), aldehyde (ddretinal), and carboxylic acid (ddRA) [21][22][23]. Several synthetic retinoids have also been developed and are used in the treatment of many dermatological diseases including cSCC (Table 2) [4,24]. The purpose of this article is to review the interactions between these retinoids and cSCC.…”