Studies show that: “After a transplant, there is generally a lag time of 3-7 years before skin cancers begin to develop. This period of time may vary depending upon individual risk factors. The longer a person takes immunosuppressant medications, the greater the risk of skin cancer. In temperate climates 40% of fairskinnned patients develop skin cancer within 20 years after transplantation. In warmer climates, up to 70% of fair-skinned patients develop skin cancer within 20 years after transplant. Therefore, Sun protection is one of the best ways to prevent skin cancer. Unfortunately only 54% of transplant patients remember receiving skin cancer education and only 40% regularly use sunscreen.”
To maintain healthy skin and prevent skin cancer after transplantation the following actions are recommended:
• Apply a broad spectrum sunscreen with a sun protection factor of at least 30 or higher.
• Make sunscreen a part of normal morning routine.
• Clothing that provides excellent protection from sun damage, (long sleeved shirt and long pants when possible).
• Regularly wear a wide brimmed hat and sunglasses with UV protection.
• Limit outdoor activity between 10 AM and 4 PM.
According to Dr.C.Ulrich in Department of Dermatology, skin cancer center of Charite University hospital, in Berlin, Germany has conducted a case control study to measure the effects of sunscreen in 60 organ transplant recipients (20 heart, 20 kidney, 20 liver) in 24 months study. These patients were provided with a free broad spectrum sunscreen (SPF > 50, high-UVA absorption) for daily application to the face, neck, forearms, and hands. Then, they were compared with a control group (60 patients) who did not use the sunscreen (from the matched age, sex, skin type, graft, transplant duration, previous post-transplant skin malignancies). The result of all 120 patients completed the 24 months study shows that in sunscreen group after 24 months, the lesion count was significantly lower than the first visit. However, the rate of new invasive SCC and BCC in control group was increased after 12 months, and 24 months. i.e.: “The sun-screen group patients developed 2 new BCC whereas in the control group the patients developed 9 new BCC.”
Results of this study can explain that the rate of SCC, BCC, and Actinic Keratosis (Ak) are increased in control group within the 2 years study, Vs. the sunscreen group, that shows a decrease in rate of these diseases in 24 months. In brief: With daily use of sunscreen, these patients had either: 1) no further progression of skin cancer or, 2) a decrease in the number of AKs and invasive non-melanoma skin cancer in organ-transplant recipients.
They conclude that: “sunscreens as part of a conclusive sun protection strategy are important pillar of preventive healthcare. Our findings lend support to the hypothesis that intensified use of cosmetically acceptable, highly protective sun screen in combination with educational programs and behavioral changes may reduce the increased risk of skin cancer development. Sun protective measures including highly protective sunscreen must be employed throughout their life.”(Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen, C.Ulrich)
However, “the physical inorganic filters (titanium or zinc oxide), which are the protective compounds in most broad-spectrum sunscreens recommended to organ transplant recipients, require a more greasy formulation; they are difficult to rub in and are comedogenic. Steroids, and also newer immunosuppressive agents such as everolimus and sirolimus (mTOR-inhibitors), are also able to induce or promote acne. Patients therefore usually try to avoid or reduce application of any additional fatty emollients to the face, including sunscreens.”
http://ndt.oxfordjournals.org/content/23/6/1805.full#sec-5
Also, "since post transplantation skin cancer becomes an increasingly important cause of morbidity and mortality in organ transplant recipients, the cost for sunscreens with medically proven efficacy should be covered by healthcare providers."
http://ndt.oxfordjournals.org/content/23/6/1805.full#sec-5
“Dermatologists recommend that organ-transplant recipients apply a sunscreen that provides:
UVA and UVB protection (label may say broad-spectrum) An SPF of 30 ,Water resistance (label may say waterproof)
To be effective, the sunscreen must be applied:
- 20 minutes before going outdoors
Liberally enough to coat the skin. - Be sure to cover all exposed areas completely.
- Pay close attention to the face, ears, hands, and arms about every two hours when outdoors — even on cloudy days, and after swimming or sweating.”
http://www.skincarephysicians.com/skincancernet/organ_transplant.html
