dermatologic disorders
Kaposi Sarcoma
Treatment of Kaposi Sarcoma
Surgical excision, cryotherapy, electrocoagulation, intralesional chemotherapy, or possibly topicalimiquimodoralitretinoinfor superficial lesions Local radiation therapy and chemotherapy for multiple lesions, diffuse involvement, or lymph node disease Antiretroviral therapy with similar local treatments or chemotherapy depending on extent of disease for AIDS-associated Kaposi sarcoma Reduction of immunosuppressants for iatrogenic Kaposi sarcoma Treatments for classic Kaposi sarcoma and AIDS-associated Kaposi sarcoma overlap considerably. Indolent lesions often require no treatment. One or a few superficial lesions can be removed by excision, cryotherapy, or electrocoagulation or treated with intralesionalvinblastineor interferon alfa. Topicalimiquimodoralitretinoinhas also been reported to be effective. Multiple lesions, diffuse involvement, and lymph node disease are treated locally with 10 to 20 Gy of radiation therapy and chemotherapy. Recurrence is common, and it is difficult to obtain a complete cure. AIDS-associated Kaposi sarcomaresponds markedly to antiretroviral therapy (ART), probably because the CD4+ count increases and the HIV viral load decreases; however, there is some evidence that protease inhibitors in this regimen may block angiogenesis (although this has not been shown to have beneficial clinical effects in humans). In patients with AIDS who have indolent local disease, CD4+ counts>150/mcL, and HIV RNA<500 copies/mL, intralesionalvinblastinecan be added.Pomalidomidecan also be used for more indolent lesions. Patients with more extensive or visceral disease can be given pegylated liposomaldoxorubicin20 mg/m2IV every 2 to 3 weeks.Paclitaxelis an alternative first-line treatment or can be given if pegylated liposomaldoxorubicinfails. Other agents being investigated as adjuncts include interleukin (IL)-12, desferrioxamine, and oral retinoids. Treatment of Kaposi sarcoma does not prolong life in most patients with AIDS because infections dominate the clinical course. requires treatment of indolent lesions as described Treatment . Iatrogenic Kaposi sarcomaresponds best to stopping immunosuppressants. In patients who have had an organ transplant, reduction of immunosuppressant dosage often results in reduction of Kaposi sarcoma lesions. If dosage reduction is not possible, conventional local and systemic therapies used in other types of Kaposi sarcoma should be instituted.Sirolimusmay also improve iatrogenic Kaposi sarcoma. Endemic Kaposi sarcomatreatment is challenging and typically palliative. 