Review Article

Dermatological Disorders following Liver Transplantation: An Update

Table 3

Bacterial skin infection after liver transplant.

Bacteria'sSkin ManifestationsTreatment

Mycobacterium tuberculosisMycobacterium tuberculosis infection is rare after transplantation.Directly observed Therapy with following drugs: pyrazinamide, rifampin, ethambutol, and isoniazid.

NocardiaResponsible for subcutaneous abscesses and nocardiosis.For lymphocutaneous type combination therapy with imipenem and cefotaxime, amikacin and TMP-SMX. However, superficial skin infections often resolve with empiric antibiotics.

Staphylococcus aureusResponsible for surgical site infection, pyoderma, staphylococcal scalded skin syndrome, and toxic shock syndrome.Intravenous flucloxacillin

E. coliResponsible for necrotizing fasciitis.Surgical debridement and earlier treatment with broad-spectrum antibiotics in addition to intravenous vancomycin or intravenous daptomycin.

StreptococcusResponsible for impetigo contagiosa, cellulitis, and ecthyma.Topical mupirocin antibiotic ointment or retapamulin ointment for 5-7 days.

BartonellaResponsible for bacillary angiomatosis.Erythromycin appears to be the antibiotic of choice and is given until lesions resolve, usually within 3-4 weeks of starting therapy. Other antibiotics used include doxycycline, TMP-SMX, tetracycline, and rifampicin.

Pseudomonas aeruginosaResponsible for ecthyma gangrenosum and necrotizing fasciitis.Surgical debridement and earlier treatment with broad-spectrum antibiotics in addition to intravenous vancomycin or intravenous daptomycin.

Nontuberculous mycobacteria (Mycobacterium marinum, M. haemophilum, M. fortuitum, M. chelonae, M. abscessus, and M. ulcerans, or M. immunogenum)Responsible for macular erythema, nonhealing ulcers, erythematous nodules, and papules.The treatment regimens vary greatly depending on the species and treatment may be required for at least 12 months.

TMP-SMX: trimethoprim-sulfamethoxazole.