Immunosuppressive agents and nonmelanoma skin cancer risk

Drug name	Mechanism	Risk of NMSC	Dermatologic side effects
Systemic glucocorticoids	Inhibit antigen presentation, induce lymphocyte toxicity, alter cytokine production	+	Acne, striae, skin fragility, ecchymosis
Azathioprine	Inhibits purine synthesis	++++	Hypersensitivity reaction including urticaria, maculopapular and vasculitic eruptions
Mycophenolate mofetil	Inhibits guanine nucleotide synthesis	+++	Nonspecific rash
Cyclosporine	Calcineurin inhibitor Decreases T cell activation and IL-2 production	++++	Hirsutism, sebaceous hyperplasia, gingival hyperplasia
Tacrolimus	Calcineurin inhibitor	+++	Alopecia
Sirolimus	Inhibits mammalian target of rapamycin Abrogates IL-2 signal transduction	+ (decreased skin cancer in clinical trials)	Impaired wound healing, acne/folliculitis, edema
Everolimus	Inhibits mammalian target of rapamycin Abrogates IL-2 signal transduction	+ (similar to sirolimus)	Mouth ulcers, stomatitis
Belatacept^[1]	Selective T cell costimulation blockade	+++ (similar to or slightly less than cyclosporine)^[2]	Alopecia, impaired wound healing, edema

NMSC: nonmelanoma skin cancer; IL: interleukin.

References:

Vincenti F, Rostaing L, Grinyo J, et al. Belatacept and long-term outcomes in kidney transplant. N Engl J Med 2016; 374:333.
Vincenti F, Blancho G, Durrbach A, el al. Five-year safety and efficacy of belatacept in renal transplantation. J Am Soc Nephrol 2010; 21:1587.

Original table modified for this publication. From: Rigel DS, Robinson JK, Ross MI, et al (Eds). Cancer of the Skin, 2nd ed, Philadelphia: Elsevier, 2011. Table used with the permission of Elsevier Inc. All rights reserved.

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Immunosuppressive agents and nonmelanoma skin cancer risk