No abstract

Skin lesions among RTRs from India consist predominantly of drug-related LAI and infections and are different from the West in view of the paucity of neoplastic lesions.

Tissue elafin is a useful immunohistochemical marker for acute skin GvHD. However, larger studies are needed to validate these results.

Acute GvHD occurs in 450% of patients 1 and mainly affects the skin, gastrointestinal (GI) tract and liver. If skin is the predominant or the only organ involved, skin-directed therapy such as phototherapy is an option. Phototherapy has been used mainly as an adjuvant treatment in steroid-refractory or steroiddependent GvHD, with responses varying from 50 to 100%. 2,3 Psoralen with UVA (PUVA) has been shown to be efficacious in both acute and chronic GvHD; 4-6 however, the theoretical risk of skin cancer and potential hepatic toxicity has prompted the use of narrow band UVB (NBUVB) in cutaneous GvHD with proven efficacy in a few series of acute GvHD and overlap syndromes recently in adults and children. 7,8 In this retrospective study, we analyzed the efficacy of NBUVB as a treatment option in acute cutaneous GVHD.Twenty patients who received NBUVB phototherapy for the treatment of acute GvHD following stem cell transplantation (SCT) with predominant skin manifestations between May 2010 and June 2013 were studied after approval by the institutional review board. During this period, 420 patients underwent SCT of which 153 (36.4%) developed acute GvHD and 120 (28.5%) had skin GvHD. The diagnosis of acute GvHD was based on clinical criteria supported by biopsy (n = 18) and on clinical criteria alone (n = 2) after excluding other etiologies such as viral exanthems and drug rashes. Transient rashes lasting o 72 h were excluded. Clinical staging was done according to the Glucksberg criteria. 9Patients received phototherapy as primary treatment along with topical steroids or topical tacrolimus when GvHD involved the skin predominantly (stage 2-3) and extracutaneous manifestations were relatively stable. It was given with oral steroids in the presence of stage 2-3 skin GvHD and significant GI or liver GvHD. It was also given for the appearance of skin GvHD following tapering of systemic steroids or other immunosuppressants (Table 1). Patients with stage 4 skin GvHD or who were unwell were not considered for treatment with NBUVB. NBUVB was administered in a full body upright UV therapy cabinet (Daavlin 3 series 311/350, Bryan, OH, USA) fitted with 24 flourescent bulbs emitting light with a 311-nm wavelength. All patients being of skin type IV or V, NBUVB was set at the lowest dose initially, the initial dose being 60 mJ/cm 2 and then gradually increased by 20-30 mJ/cm 2 , and was given on alternate days either twice or thrice weekly. It was discontinued if the patient was clinically clear of rash or developed significant GvHD in other organ systems or if patient was unable to come for the phototherapy sessions. A complete remission (CR) was defined as complete clearance of lesions with no evidence of cutaneous GvHD at the end of the treatment. Partial remission was defined as reduction of lesions, either a reduction in the erythema or in duration of lesions, or in percentage of body surface area involved by the end of treatment, and no response when there was no reduction with phototherapy or there was worsening of skin ...

In a prospective study conducted between November 2006 and April 2008 of 35 patients (male:female ratio 2:1) with proven rickettsial spotted fever, a generalised rash with involvement of palms and soles were seen in 80% of patients. Vasculitis on histopathology of rash was seen in 54%.