Calcinosis Cutis in the Setting of Chronic Skin Graft-Versus-Host Disease

Abstract

cluded. One patient who did not adhere to topical corticosteroid therapy and 3 patients with less than 5 years of follow-up (or loss to follow-up) were excluded. In the remaining 11 patients, mean age at diagnosis of primary lesion was 62.9 years (range, 26-88 years). Initial management of vSCC or dVIN included surgical excision alone in 4 patients, surgical excision with node biopsy in 2 patients, surgical excision with node dissection in 4 patients, and surgical excision with adjuvant laser therapy in 1 patient. Of 11 patients, 8 (73%) remained free of recurrence with a mean follow-up of 10.5 years (range, 5.1-16.5 years) (Table ). Two patients (18%) had recurrence of their vSCC, 1 of whom developed multiple recurrences of vSCC, and 1 patient (9%) had recurrence of their dVIN.Discussion | In the study cohort, patients with vLS who adhered to topical corticosteroid therapy had a vSCC or VIN recurrence rate of 27% compared with reported 5-year recurrence rates of 44% to 47%. 4,5 Only 1 patient with a recurrence of vSCC or dVIN had a subsequent recurrence compared with the 5-year subsequent recurrence rate of 80% for untreated vLS. 5 It has been hypothesized that chronic inflammation contributes to the increased risk of developing vSCC; thus, the antiinflammatory effect of topical corticosteroid may confer a protective benefit. 6 Topical corticosteroid treatment is inexpensive and safe 3 and could result in considerable cost savings and reductions in morbidity and mortality.A limitation of the present study is that it is a singlecenter retrospective medical record review with a small sample size; there was no control group (patients not treated with a topical corticosteroid) for comparison. A strength of the study is that all included patients were part of a large cohort with vLS who have been followed up prospectively since 2008. Larger prospective studies including a control group for comparison would strengthen the evidence of the findings in this report.Topical corticosteroid therapy may represent an important management strategy to reduce the recurrence rate of vSCC and dVIN in patients with vLS. These findings suggest the need for a large prospective trial. However, in the meantime, we encourage dermatologists to play an active role in assisting colleagues who specialize in gynecology-oncology to use a topical corticosteroid when treating patients with vLS.

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

“…A total of 410 articles were retrieved from the search. Additionally, ten more studies were added after the manual screening of the reference sections [ 10 , 17 – 25 ]. Eight articles were excluded at the eligibility stage due to reporting patients described in other included studies [ 20 , 26 , 27 ] or insufficient data [ 24 , 25 , 28 – 30 ].…”

“…Additionally, ten more studies were added after the manual screening of the reference sections [10,[17][18][19][20][21][22][23][24][25]. Eight articles were excluded at the eligibility stage due to reporting patients described in other included studies [20,26,27] or insufficient data [24,25,[28][29][30]. In the selection process, 40 records met the eligibility criteria and were included in this systematic review (Fig.…”

AT1R Activating Autoantibodies in Hematopoietic Stem Cell Transplantation

“…33,34 Lastly, Saardi et al recently reported GVHD-associated calcinosis cutis development in seven post-HSCT patients, and calcinosis cutis has been most commonly associated with systemic sclerosis, a condition that shares many phenotypic features with skin GVHD. 35 Further work will be needed to clarify if elevated AT1R-AA levels contribute to this pathology.…”

Innate Immunity in Calcinosis Cutis

“…While no large-scale retrospective study has identified a clear association between ANA and CC, numerous case reports and series have found a potential link. A case series of patients with chronic graft-versus-host disease found that four out of five patients with CC had elevated ANA titers [81]. Diffuse CC has been described in patients with Sjogren's syndrome and SLE with positive ANA [82,83].…”