Cutaneous Graft-Versus-Host Disease: Diagnosis and Treatment

Abstract

Graft-versus-host disease (GVHD) is an immunological reaction and a frequent complication following allogeneic hematopoietic stem cell transplantation. It is associated with high mortality rates and may have a significant negative impact on the patient’s quality of life, particularly in the chronic-stage setting. Many different organs can be involved, which leads to a wide range of clinical manifestations. In this context, dermatologists play a key role by diagnosing and treating GVHD from the outset since cutaneous features are not just the most common but are also usually the presenting sign. Several skin-direct therapies are available and may be indicated as monotherapy or adjuvant treatment in order to allow faster tapering and withdrawal of systemic immunosuppression. Treatment of steroid-refractory patients remains a challenge and, to date, no consensus has been reached for one single agent in second-line therapy. This article aims to review skin involvement as well as provide and update discussion on therapeutic options for both acute and chronic cutaneous GVHD.

Depression following graft-versus-host disease in a patient with acute lymphoblastic leukaemia: A case report

“…Inflammation is increasingly considered as an etiological factor for depression (2,18,19). It is worth noting that the patient whose case is presented herein had developed skin hyperpigmentation, which is a post-inflammatory manifestation of GVHD (20). Given that the patient was in a good mental state not only premorbidly, but also during the several months post-HCT (which makes the possibility of his depression being reactive to the psychological burden of his diagnosis and treatment less likely), it is possible that the GVHD-induced neuro-inflammation triggered the acute onset of a severe depressive episode.…”

Cutaneous Inflammation: Prototypes of Immunological Mechanisms Involving the Skin

“…Unlike SJS/TEN and erythema multiforme, scattered dermal eosinophils may be present. • Prognosis and treatment: Patients require treatment proportionate to their disease extent (Strong Rodrigues et al 2018). Topical and systemic corticosteroids, topical calcineurin inhibitors, mycophenolate mofetil, cyclosporine, azathioprine, ibrutinib, mTOR, and JAK inhibitors (e.g., ruxolitinib) are used for the treatment (Martin et al 2012).…”

Unraveling the Mechanisms of Cutaneous Graft-Versus-Host Disease

“…The skin is the most frequently affected organ both in acute and chronic GVHD ( 15 , 16 ), and the cutaneous manifestations are often the presenting sign of the disease ( 17 ); the extent of involvement correlates with prognosis either by acting as a surrogate for GVHD severity at other sites ( 18 ), or more directly, by leading to loss of essential barrier functions and infections. In its acute form, the most prominent skin features include the sudden development of a symmetrical maculopapular rash, predominantly on the upper back and neck, the palms/soles, and face, which may progress to a diffuse erythroderma with the formation of bullae and epidermal necrosis ( 19 ).…”

“…Lichen planus-like eruptions and poikiloderma affecting the dorsal aspects of the hands, forearms, and trunk are the most typical features of early stage non-sclerotic cutaneous chronic GVHD, its histopathological hallmarks being hyperkeratosis, focal hypergranulosis, acanthosis, basal cell necrosis, vacuolar degeneration of the basal layer, and a distinctive superficial perivascular or band-like lymphoid cell infiltrate with perifollicular fibrosis ( 20 ). Sclerodermatous lesions usually develop progressively over the trunk, buttocks, hips, and thighs, with localized morphea-like features, diffuse sclerosis, or lichen sclerosus-like features, characterized by collagen homogenization of the dermis and/or subcutaneous tissues ( 17 , 20 ). In this mini-review, we will address the pathophysiology of cutaneous GVHD as addressed mostly using models of experimental allo-HSCT in mice, highlighting recent advances in the field and discussing some of the key challenges that remain.…”