SPF 50 shields transplant patients against SCC, BCC

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SPF 50 shields transplant patients

against SCC, BCC

June 1, 2007 By: Ilya Petrou, M.D. Dermatology

Times

Berlin — As many as 90 percent of all organ transplant

recipients (OTR) experience skin disease.  These patients are highly susceptible to

developing squamous and basal cell carcinoma, as well

as precancerous lesions, such as actinic keratoses.

" Against a backdrop of

life-long immunosuppression, ultraviolet radiation

appears to be the major risk factor in the onset on nonmelanoma

skin cancer. The key concern is the increased

incidence of skin cancer, paralleling the extended survival rates of organ

transplant patients, " explains Claas Ulrich,

M.D., of the department of dermatology at the The Charité in Berlin.

SPF study

Dr. Ulrich and his team conducted

a two-year case control study to test the effectiveness of SPF 50 sunscreen in

organ transplant patients.  The study

included 60 organ transplant recipients (20 heart, 20 liver and 20 kidney) who

applied a specific liposomal, waterproof SPF 50

sunscreen (Daylong Actinica, Spirig,

Switzerland) daily on all sun-exposed areas. Results

of the analysis were compared to an age- and transplant-matched case control

group retrospectively recruited from an existing computerized database. The controls did not receive sunscreen.

In the sunscreen treatment group,

Dr. Ulrich found that after two years, the 60 OTR showed a 53 percent reduction

of actinic keratoses and no newly developed squamous cell carcinomas, as compared with the control

group, which showed 38 percent new actinic keratoses

and eight newly developed squamous cell carcinomas.

Interestingly, the effect on basal

cell carcinoma was less pronounced, as there was no significantly increased

protection seen in the sunscreen group when compared to the control group.

Compliance

" A pivotal point in the study

was the compliance of the sunscreen group to actually use the sunscreen.  Dr. Ulrich says that organ transplant patients

usually already have seborrheic skin related to their

calcineurin and corticosteroid inhibitor-based

immunosuppressive treatment. Adding insult to injury,

sunscreens often additionally cause acneiform,

irritant dermatitis and aesthetic issues (whitening effect), making true

compliance a real issue in these patients.

Dr. Ulrich notes that most

probably due to thorough oral and written patient instruction and information,

as well as the cosmetically appealing preparation of the liposomal

sunscreen (nonwhitening, waterproof, low-fat) the

compliance in the sunscreen group was excellent, despite a nonsignificant

trend toward more acne. He adds that this point shows

the importance of an optimal galenic preparation of

sunscreens.  The results in this group

showed that in addition to the prophylaxis against invasive squamous

cell carcinoma, there was no progression of and a spontaneous clearance of

actinic keratoses, compared with the control group. " Sunscreens reduce indirect and direct carcinogenic

effects of sunlight in humans. Especially highly

immune compromised patients, such as the heart transplant recipients, seem to

benefit from regular use of sun protection measures, indicating that the

development of nonmelanoma skin cancers in OTR is not

only related to further induction of DNA damage by UV radiation, but also to

its topical immunosuppressive effects, " Dr. Ulrich says.  Other patients with immunodeficiency might

also benefit from these observations, Dr. Ulrich says.

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