Book contents
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- 32 Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 33 In-Transit Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 34 Metastatic Malignant Melanoma in Organ Transplant Recipients
- 35 Transplant Scalp: Severe Actinic Damage of the Scalp in Organ Transplant Recipients
- 36 Transplant Lip: Severe Actinic Damage of the Vermilion in Organ Transplant Recipients
- 37 Transplant Hands: Severe Actinic Damage of the Hands in Organ Transplant Recipients
- 38 Skin Cancer and Nevi in Pediatric Organ Transplant Recipients
- 39 Dermatologic Surgery in Organ Transplant Recipients
- 40 Radiation Therapy in Organ Transplant Recipients
- 41 Reduction of Immunosuppression for Transplant-Associated Skin Cancer
- 42 Systemic Retinoids for Prevention of Skin Cancer in Organ Transplant Recipients
- 43 Topical Treatment of Actinic Keratosis and Photodamage in Organ Transplant Recipients
- 44 Imiquimod Use in Organ Transplant Recipients
- 45 Photodynamic Therapy in Organ Transplant Recipients
- 46 Skin Cancer Prevention and Photoprotection in Organ Transplant Recipients
- 47 Skin Cancer Prior to Organ Transplantation or Organ Donation
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
44 - Imiquimod Use in Organ Transplant Recipients
from Section Eight - Special Scenarios in Transplant Cutaneous Oncology
Published online by Cambridge University Press: 18 January 2010
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- 32 Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 33 In-Transit Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 34 Metastatic Malignant Melanoma in Organ Transplant Recipients
- 35 Transplant Scalp: Severe Actinic Damage of the Scalp in Organ Transplant Recipients
- 36 Transplant Lip: Severe Actinic Damage of the Vermilion in Organ Transplant Recipients
- 37 Transplant Hands: Severe Actinic Damage of the Hands in Organ Transplant Recipients
- 38 Skin Cancer and Nevi in Pediatric Organ Transplant Recipients
- 39 Dermatologic Surgery in Organ Transplant Recipients
- 40 Radiation Therapy in Organ Transplant Recipients
- 41 Reduction of Immunosuppression for Transplant-Associated Skin Cancer
- 42 Systemic Retinoids for Prevention of Skin Cancer in Organ Transplant Recipients
- 43 Topical Treatment of Actinic Keratosis and Photodamage in Organ Transplant Recipients
- 44 Imiquimod Use in Organ Transplant Recipients
- 45 Photodynamic Therapy in Organ Transplant Recipients
- 46 Skin Cancer Prevention and Photoprotection in Organ Transplant Recipients
- 47 Skin Cancer Prior to Organ Transplantation or Organ Donation
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
Summary
Organ transplant recipients (OTRs) are disproportionately afflicted with premalignant and malignant skin lesions, with significant associated morbidity and mortality. Because of the intense immunosuppressive therapy necessary to sustain their grafts, the cutaneous malignancies they develop are more numerous and more dangerous than those of immunocompetent individuals. It is imperative that premalignant and localized malignant lesions are treated early in organ transplant recipients. Many modalities are utilized for this purpose, including surgical and nonsurgical approaches. The use of the topical immunomodulator imiquimod in OTRs is intriguing because it relies on the induction of a local immune response in patients with iatrogenically modified immune systems. However, it is important to consider whether this local immune induction poses a threat to the transplanted organ.
Imiquimod is a topical chemotherapeutic agent of the imidazoquinoline family. It is an immune response modifier with antitumor and antiviral properties that induces migration and activation of dendritic (antigen-presenting) cells. Imiquimod binds to and stimulates cell surface receptors, such as Toll-like receptors 7 and 9, on macrophages and other dendritic cells. These cells then secrete proinflammatory cytokines that tip the balance of the immune response to a cell mediated, or TH-1, mode. The cytokines secreted by the activated dendritic cells include interferon α (IFN-α), tumor necrosis factor α (TNF-α), and interleukins (IL) 1 and 12. These cytokines stimulate activated T cells to secrete IL-2 and IFN-γ which, in turn, induce more macrophage secretion of IL-12. A positive feedback mechanism is thus generated and is self-perpetuating.
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- Skin Disease in Organ Transplantation , pp. 286 - 290Publisher: Cambridge University PressPrint publication year: 2008