ABSTRACT
Background: Autoimmune diseases are a vast array of organ-specific
as well as systemic diseases, whose pathogenesis results from the activation of
B and T lymphocytes reacting against antigens of the body’s own tissues
(defined as self). Objective: To record skin tumors and infections in all
autoimmune diseases gathered together in a one pathological state, compared
with renal transplant recipients and normal control. Patients and Methods: Four
hundred patients with different autoimmune diseases were examined. Fifty
patients with pemphigus (15 males, 35 females) are aged from 20 - 70 (41.23 ± 3.89)
years. Fifty patients with systemic lupus erythematosus (50 females) are aged
from 17 - 45 (30.58 ± 10.08) years. One hundred patients with vitiligo (59
males, 41 females) are aged from 9 - 71 (42.89 ± 5.28) years. One hundred
patients with alopecia areata (42 males, 58 females) are aged from 7 - 52 (38.67
± 9.52) years. One hundred patients with psoriasis (56 males, 44 females) are
aged from 7 - 71 (47.36 ± 8.62) years were evaluated. One hundred twenty kidney
transplant recipients’ (101 males, 19 females) ages ranged from 14 - 70 (45.43 ±
4.63) years. All patients were examined thoroughly for any cutaneous
manifestations and tumors and the findings were compared with the general
population as a control group, which consisted of 500 healthy control
individuals whose ages ranged from 20 - 71 (44.53 ± 11.48) years. This case
series, descriptive, controlled study was performed in Baghdad Teaching
Hospital from June 2014 to October 2015. Results: In renal transplant
recipients, the findings were observed as follow herpetic infection in 30(25%),
bacterial 12(10%) while fungal 24(20%) patients. These infections appeared
early in the course of immunosuppression. While the tumors were noticed, the
benign tumors were the commonest manifestations, which included viral warts in
45(37.5%) followed by actinic keratosis 15(12.5%), seborrheic keratosis
14(11.6%), sebaceous hyperplasia 13(10.8%) and keratoacanthoma 1(0.8%). While
the malignant tumors were basal cell carcinoma 4(3.3%) followed by squamous cell
carcinoma 3(2.5%), and kaposi’s sarcoma 4(3.3%), Bowen’s disease 1(0.8%). These
malignancy usually appeared late in the course of immunosuppression. In
pemphigus, viral warts were observed in 4(8%) cases; fungal infection was seen
in 4(8%) cases and bacterial infections in 2(4%) of cases and herpetic
infection in only 1(2%) of case; no tumors were found in all patients. In
vitiligo, viral warts were observed in 2(2%) cases, while seborrhic keratosis
and sebaceous hyperplasia were observed in 1(1%) case; herpetic and fungal
infections were seen in 3(3%) of cases while bacterial infections were recorded
in 2(2%) of cases but no tumors were found in all patients. In alopecia areata
viral warts were observed in 9(9%) of cases, sebaceous hyperplasia in 1(1%)
case, herpetic and bacterial in 3(3%) of cases and fungal in 4(4%) of cases; no
tumors were found in all patients. In systemic lupus erythymatosus (SLE) viral
warts were observed in 4(8%) of cases, herpetic infection in 12(12%) of cases,
fungal infection in 10(20%) of cases, bacterial infection in 3(3%) of cases and
sebaceous hyperplasia in only 1(2%) of case, but no tumors were seen. In
psoriasis, viral warts were observed in 14(14%) of cases, herpetic infection in
10(10%) of cases, bacterial infection in 3(3%) of cases, fungal infection in
2(2%) of cases, sebaceous hyperplasia in 2(2%) of cases and seborrhiec
hyperkeratosis in 1(1%) case, while no tumors were demonstrated. In healthy
control individuals, herpetic infection was present in 36(7.2%) and viral warts
in 52(10.4%) individuals, fungal infection in 29(5.8%) of individuals and
regarding tumors solar keratosis was present in 24(4.8%); basal cell carcinoma
and squamous cell carcinoma were present in 2(0.4%) individuals of each. Conclusions:
Patients with autoimmune diseases were protected against infections and tumors
while kidney transplant recipients had no such protection although all these
groups were on prolonged immunosuppression.