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Use of Topical and Systemic Retinoids in Solid Organ Transplant Recipients

Update and Review of the Current Literature

Herold, Mitchell BS*; Good, Allison J. BA*; Nielson, Colton B. MD; Longo, Maria I. MD, PhD

doi: 10.1097/DSS.0000000000002072
Review Article

BACKGROUND Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy.

OBJECTIVE To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs.

MATERIALS AND METHODS Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population.

RESULTS Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients.

CONCLUSION Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.

*College of Medicine, University of Florida, Gainesville, Florida;

Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida

Address correspondence and reprint requests to: Maria I. Longo, MD, 4037 NW 86th Terrace, 4th Floor, Gainesville, FL 32606, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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