Acitretin treatment of premalignant and malignant skin disorders in renal transplant recipients:: Clinical effects of a randomized trial comparing two doses of acitretin
Acitretin treatment of premalignant and malignant skin disorders in renal transplant recipients:: Clinical effects of a randomized trial comparing two doses of acitretin
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DOI：
10.1067/s0190-9622(03)01831-0
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发表时间：
2003-09-01
影响因子：
13.8
通讯作者：
Hoitsma, AJ
中科院分区：
文献类型：
--
作者：
de Sévaux, RGL;Smit, JV;Hoitsma, AJ
导言：肾移植术后，癌前病变和恶性皮损的发生率较高。阿维A治疗改善了光化性角化病的数量和方面，似乎减少了鳞状细胞癌的发生率，但治疗受到频繁副作用的阻碍。方法：26例长期肾移植受者随机接受阿维A治疗1年，治疗前3个月为0.4 mg/kg/d，其余9个月为0.2 mg/kg/d。在9个不同的时间点，计数光化性角化病和肿瘤的数量，并对红斑、皮损厚度和不良反应的严重程度进行评分。结果：在两组患者中，光化性角化病的数量减少了近50%，但研究年内新发恶性肿瘤的数量与研究前一年的肿瘤数量相似。两组患者角化厚度均明显减少。大多数患者不得不减少阿维A的剂量，因为经常发生粘膜皮肤副作用，如唇炎、皮肤过度脱皮和毛发紊乱。在随机接受0.4 mg/kg/d持续治疗的14例患者中，只有3例患者可以维持该剂量。26例患者中有7例需要暂时中断阿维A治疗。患者对皮肤的满意度显著增加，组间差异无统计学意义。结论：低维持剂量(0.2 mg/kg/d)的阿维A治疗可减少肾移植受者光化性角化病的数量，并显著减轻皮损的厚度。然而，新的皮肤恶性肿瘤的发生率保持不变。尽管黏膜皮肤副作用的发生率很高，但患者对皮肤方面的满意度显著增加。
Introduction: After renal transplantation, the incidence of premalignant and malignant skin lesions is high. Treatment with acitretin improves the number and aspect of actinic keratoses and appears to reduce the incidence of squamous cell carcinomas, but treatment is hampered by frequent side effects. No optimal long-tern dosing advice is available.Methods: A total of 26 long-term renal transplant recipients were randomized to 1-year treatment with acitretin, either 0.4 mg/kg/d throughout the whole year or 0.4 mg/kg/d during the first 3 months followed by 0.2 mg/kg/d for the remaining 9 months. At 9 different time points, the number of actinic keratoses and tumors was counted, and erythema and thickness of the lesions, and severity of side effects were scored. Patient's judgment was recorded using visual analog scores.Results: In both groups, the number of actinic keratoses decreased by nearly 50%, but the number of new malignant tumors during the study year was similar to the number of tumors in the year before the study. Thickness of the keratoses decreased significantly in both groups. Acitretin dose had to be reduced in most patients because of the frequent occurrence of mucocutaneous side effects, such as cheilitis, excessive peeling of the skin, and hair disorders. In the 14 patients randomized to continuous treatment with a dose of 0.4 mg/kg/d, this dose could be maintained in 3 of 14 patients only. Temporary interruption of acitretin therapy was necessary in 7 of 26 patients. Patients' contentment about the aspect of their skin increased significantly, with no differences between groups.Conclusions: Acitretin therapy decreased the number of actinic keratoses in renal transplant recipients at a low maintenance dose of 0.2 mg/kg/d and significantly decreased the degree of thickness of the lesions. However, the incidence of new skin malignancies remained unchanged. Despite the high incidence of mucocutaneous side effects, patient's contentment with the aspect of their skin increased significantly.