Pemphigus vulgaris in prolonged immunosuppression is immunoprotective against skin infections and skin tumors while kidney transplant recipients are not protective.

Background: Epidermodysplasia verruciformis (EV) is a skin disease associated with numerous early onset viral warts on the sun exposed parts of the body that usually progress into different skin malignancies. Kidney transplant patients are also commonly associated with viral warts that might change into skin cancers. Objective: To re-evaluate all features of the acquired epidermodysplasia verruciformis in kidney transplant patients in comparison with healthy individuals. Patients and Methods: This case controlled study that included 100 patients with kidney transplantation(87 males, 13 females) their ages ranged from 14-70(46.65 ± 4.74) years and was done in kidney Transplantation Centers in Baghdad and Al-Karma Teaching Hospitals from June 2009-August 2010. Patients included were receiving multiple immunosuppressive drugs like azathioprine, prednisolone, cyclosporine, mycophenolate mofetil ranged from 6 months-25 years. One hundred healthy individuals (70 males, 30 females), there ages ranged from 14-73 (41.63 ± 9.55) years, had been examined as a control for the presence of viral warts and tumors. These control cases had been taken randomly from general population in multiple regions in Baghdad Results: Forty (40%) patients out of one hundred kidney transplant patients had viral warts and were seen in 9(9%) of control group and there was statistically significant difference between patients and control cases (P value < 0.00001). Most of the viral warts were multiple and of the verrucae vulgaris type and were mainly located on the exposed areas of the body, mostly on the face and dorsa of the hands. Solar keratosis admixed with viral warts were found in 14 out of 100 kidney transplant patients. Skin malignancies in these fourteenth patients were observed in 6 (42.14%) cases: 2 SCC and 4 basal cell carcinoma (BCC) and these were mainly located on the exposed areas of the body, mostly on the face and dorsa of the hands. No skin malignancies were observed in control group. Conclusions: Kidney transplant recipients had all the features that simulate the inherited Epidermodysplasia Verruciformis