Cosmetically disfiguring side effects of cyclosporine A in an adolescent population

Abstract

Cyclosporine A (CsA) is a potent immunosuppressive agent commonly used in nephrotic syndrome and in organ transplanted patients. However, its applications are limited, due to undesirable adverse effects. The cutaneous manifestations of the drug are well documented in the western countries and some studies indicate a higher incidence among Asian populations. However, there is paucity of data about its cutaneous side effects on Asian patients thus making it difficult to counsel patients and parents before its use. We recruited children and adolescents between 12 and 20 years attending the nephrology clinic at a tertiary care hospital in Sri Lanka who have been receiving CsA more than a year. Patients who received other medication which may aggravate gingival hyperplasia, acne or hypertrichosis were excluded from the study. The dermatological manifestations of the selected children were assessed and recorded by experienced clinicians. Our study consisted of 64 patients who satisfied the inclusion criteria. There were 41 male and 23 females with a median age of 16.6 years. All of them received CsA at a dose between 5-10 mg/kg/day at induction, which was tapered towards a dose of 3 mg/kg/day, based on clinical status as well as serum level of the drug. Among the clinical features observed, hypertrichosis was seen in 32 males (78%) and in all 23 female patients (100%); Gum hypertrophy was seen in 34 patients (53%) and acne was noted only in 8 patients. The commonest cutaneous side effect was hypertrichosis, significantly seen among female subjects, which is a serious point of distress to patients and their families. Gum hypertrophy was also observed among a significant number but could be reduced by regular dental care. These findings will be remarkably useful when counselling before commencing on CsA therapy in adolescent patients.