el-Shahawy M A, Gadallah M F, Massry S G
Department of Medicine, USC School of Medicine, Los Angeles 90033 USA.
Nephron. 1996;72(4):679-82. doi: 10.1159/000188960.
A renal transplant recipient who developed severe acne 6 months after transplantation is described. Maintenance immunosuppression consisted of cyclosporine A (CsA), azathioprine and prednisone. Tapering the prednisone dose to as low as 5 mg/day, in addition to topical tetracycline, Retin-A cream, and systemic antimicrobial therapy failed to control the progression of the skin lesions. Despite therapy with isotretinoin (Accutane), the lesions continued to progress with nodulocystic transformation (acne conglobata) and isotretinoin was discontinued after 4 months. However, the condition continued to worsen with the development of a systemic illness with daily fever, diaphoresis, and depression. High fever (103 degrees F) with shaking chills prompted hospitalization. Withdrawal of CsA resulted in rapid and continuous improvement of the skin lesions. After 12 months of follow-up, the lesions significantly resolved except for residual areas of scarring. No episodes of acute allograft rejection occurred. In conclusion, we suggest that CsA therapy may be associated with the development of acne. Nodulocystic transformation (acne conglobata) may occur despite the use of isotretinoin. Finally, withdrawal of CsA may lead to resolution of the skin disease and should, therefore, be considered as a therapeutic option for severe and treatment-resistant cases.
本文描述了一位肾移植受者，其在移植后6个月出现了严重痤疮。维持性免疫抑制治疗包括环孢素A（CsA）、硫唑嘌呤和泼尼松。除了外用四环素、维甲酸乳膏和全身抗菌治疗外，将泼尼松剂量减至低至5毫克/天仍未能控制皮肤病变的进展。尽管使用异维A酸（泰尔丝）治疗，病变仍继续进展并出现结节囊肿性转变（聚合性痤疮），4个月后停用异维A酸。然而，病情继续恶化，出现了每日发热、多汗和抑郁的全身性疾病。高热（华氏103度）伴寒战促使患者住院。停用CsA后，皮肤病变迅速且持续改善。经过12个月的随访，除了残留的瘢痕区域外，病变明显消退。未发生急性移植肾排斥反应。总之，我们认为CsA治疗可能与痤疮的发生有关。尽管使用了异维A酸，仍可能发生结节囊肿性转变（聚合性痤疮）。最后，停用CsA可能导致皮肤病消退，因此，对于严重且难治性病例应考虑将其作为一种治疗选择。
