Cutaneous graft-versus-host disease after hematopoietic stem cell transplant - a review

Abstract

Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease's mechanisms and the different treatments for acute and chronic skin graft-versus-host disease.

Chronic graft-versus-host disease – the role of dermatological treatment

“…Basic dermatological recommendations applicable to transplant recipients include: -avoidance of sun exposure, particularly between 10 am and 4 pm; and regular use of photoprotective methods (protective clothing; application of SPF30 (or higher) sunscreen prior to sun exposure) due to the risk of GVHD exacerbation, development of skin cancer, post-inflammatory hyperpigmentation and phototoxic reactions (in patients treated with azithromycin, fluoroquinolones, hydrochlorothiazide, trimethoprim with sulphamethoxazole, voriconazole) [7,8], leczenie miejscowe (maści keratolityczne, glikokortykosteroidowe, emolienty). Dzięki zastosowanej terapii uzyskano poprawę stanu miejscowego, zmniejszenie bolesności rąk i stóp i ułatwienie poruszania się.…”

“…azytromycynę, fluorochinolony, hydrochlorotiazyd, trimetoprim z sulfametoksazolem, worikonazol) [7,8], -regularną pielęgnację skóry za pomocą emolientów lub preparatów z 3-10% mocznikiem, co pomaga…”

“…Dermatology Review/Przegląd Dermatologiczny 2017/2 -regular skin care with emollients or formulations containing 3-10% urea, which helps to normalize the skin's moisture content, restore the lipid barrier and reduce pruritus, -annual dermatological examinations for cancers of the skin and mucous membranes due to an elevated risk of actinic keratosis, basal cell carcinoma and squamous cell carcinoma; in patients with a history of skin cancer the frequency of dermatological assessments during immunosuppressive therapy should be increased, with examinations performed on a 6 monthly basis; after the completion of immunosuppressive therapy follow-up examinations may be performed once a year [7,8], -regular dermoscopic assessment due to an increased risk of melanoma in allo-HSCT recipients [7][8][9], -earliest possible introduction of therapy in patients with sclerotic GVHD due to the risk of joint contractures and reduced mobility; treatment should be combined with regular physiotherapy. Even though cGVHD is a systemic disease with complex pathophysiology, topical treatment plays an important role in the care provided to allo-HSCT recipients.…”

“…Drugs used in topical skin treatment include GCs and calcineurin inhibitors (preferred option on the skin of the face and intertriginous areas, and in children) [7]. In mild forms of cGVHD, first-line treatment should be based on moderate-or high-potency GCs.…”

“…A number of authors recommend the use of higher-potency GCs at the start of therapy in order to achieve a rapid improvement in skin condition, to be followed by a gradual introduction of lower-potency GCs or a decrease in the frequency of glucocorticosteroid use. The above regimen makes it possible to avoid the risk of tachyphylaxis [7,8].…”