• Your face may be more rounded, and your cheeks may be rosier. This is termed ‘moon facies’. Some people would consider this cute. There may also be an increase in acne. These are side- effects of the corticosteroid drug.

• You will notice more facial hair growth. This is called hirsuitism and can be caused by both corticosteroids and cyclosporine drug. The hair growth is not confined to your face and can in fact occur anywhere on the body. It is a cosmetic concern for female patients and they could opt for cosmetic procedure such as bleaching or hair removal creams.

• You may also notice a ‘fuller’ smile. Your gums may be more obvious than before. This is called gum hypertrophy, and occurs as a result of cyclosporine.

Swollen gums

• You may notice that your hands seem to be shaking more. It would seem that you are more ‘nervous’ than before. These shaking of the hands occurs as a result of calcineurin inhibitor drug.

  If you develop tremors only after a sudden increase in your dose of calcineurin inhibitors, it would be prudent to check with your doctor as the blood levels of the drug may be raised.

Hand Shaking or tremor

• You may notice an increase in weight, where you may look heavier centrally, as in the torso and abdomen, compared to the limbs. You may also see purple ‘stretch’ scars over the skin of the abdomen. Your shoulders may seem more prominent, with fat accumulating between your shoulder blades at the back. This is called Cushing’s syndrome due to effects of corticosteroid drug.

Cushing’s syndrome with central obesity and abnormal stride

• Your skin may also be thinned for example on the limbs. This causes easy bruising with even slight trauma. It is important that you take special precautions to avoid injuring yourself in your daily routine.

Bruises over the hand

• Fungal infection is commonly seen which may appear in several forms. You may have thickened brittle finger nails. You may also have white residue appearing between the webs of your fingers, or circular red rings on your skin. These are easily treated with anti-fungals given by your doctor.

Fungal infections of finger nails

• If you notice appearing of any suspicious lumps in your body, you need to speak to your doctor about them early. The lumps may be the beginning of certain diseases such as cancers.

Neck lumps

• f you have appearing new skin discolouration or moles on your body which were not there before, you also need to inform your doctor early as it can be signs of skin cancers.

• You may notice your legs to be swollen if you are taking MTOR inhibitors. The swelling occurs as a result of a lack of protein in your body, causing the fluid from inside your blood vessels to escape into the surrounding tissue. This is reversible once the drug is removed.