Bullous scleroderma‐like changes in chronic graft‐versus‐host disease

Abstract

Cutaneous graft-versus-host disease (GVHD) is the most common clinical setting for GVHD after bone marrow transplantation. Chronic cutaneous GVHD is categorized according to the type of skin lesions into lichenoid and sclerodermoid variants, but bullous scleroderma-like changes are exceptional. Recently, we studied a patient with these alterations. This is the second case described in the literature.

Lichen sclerosus and eosinophilic fasciitis as manifestations of chronic graft-versus-host disease: Expanding the sclerodermoid spectrum

“…15,49 However, many cases of morpheaform GVHD might be more accurately described as overlap lesions demonstrating epidermal and papillary dermal changes of LS in combination with deeper changes characteristic of morphea. 50 Moreover, considering the histologic resemblance of early lesions of LS to lichen planus, LS may also represent a link between lichenoid and sclerodermoid forms of chronic GVHD.…”

Blistering plaques.

“…Fresh plaques are violaceous in colour and progressively whiten. Bullous formation is generally regarded as being an aggressive form of the disease 2 . The pathogenesis of bullous formation is unknown but may result from lymphatic obstruction secondary to the sclerodermatous process 3 .…”

“…Bullous development in collagen vascular disease is rare but has been reported in lupus erythematosus, dermatomyositis and scleroderma. Scleroderma‐like changes with bullous formation have also been described in association with chronic graft‐versus‐host disease 2 . Other differential diagnoses that must be considered include bullous pemphigoid, bullous lichen sclerosus and epidermolysis bullosa acquisita.…”

Linear IgA dermatosis in an immunosuppressed patient after allogenic bone marrow transplantation

“…4 Until now only one case report has described a heart transplant recipient on immunosuppressive therapy including, as in our case, cyclosporin and prednisolone who developed LAD. 21 However, several reports have described other bullous diseases such as bullous pemphigoid, 22 (paraneoplastic) pemphigus 23 or scleroderma-like changes 24 in patients after BMT.…”