Cutaneous manifestations of chronic graft‐versus‐host disease

Abstract

Graft-versus-host disease (GVHD) occurs in a number of clinical settings. It is well recognized after bone marrow transplantation, an increasingly used therapeutic option for haematological disorders. Chronic GVHD, occurring at an interval greater than 100 days post-transplant, has many systemic manifestations, but it is the cutaneous manifestations which are most frequent and often most troubling to the patients. In this review article, the wide spectrum of cutaneous chronic GVHD (including involvement of hair, nails and mucosae), and its complications and associations are discussed. The clinical and histological features and management guidelines are presented to assist the dermatologist with diagnosis and treatment of this condition.

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

“…Our patients demonstrated several additional cutaneous findings that have been previously observed in association with chronic GVHD, including ulcers, scarring alopecia, poikiloderma, nodular fibromas, angiomas, and photosensitive eruptions mimicking subacute cutaneous lupus erythematosus. 3,4,10,11,15,[40][41][42][43] Although xerosis and ichthyosiform changes are often seen in recipients of hematopoietic stem cell transplants, 40,44 the distinctive pattern of eczema craquelé involving the posterior axillary folds exhibited by 4 of our patients has not been previously described. This finding may be related to the sweat gland destruction that is often noted in biopsy specimens from patients with chronic GVHD.…”

Sclerodermatous Graft-vs-Host Disease

“…This classification agrees with those of other authors who have found that lichenoid and sclerodermatous cGVHD occur independently. 7,8 Nevertheless, most of the biopsy results of our patients with ScGVHD showed vacuolar degeneration in the basal cell layer of the epidermis and some necrotic keratinocytes, suggestive of interface dermatitis but not enough to classify them histologically as lichenoid. Several authors 2,5 reported vacuolar degeneration as a rare finding in ScGVHD, and that when found, it may indicate an earlier lesion that is still evolving.…”

“…5,6 Nevertheless, few data are available regarding the late sclerodermatous phase of cGVHD (ScGVHD), and no large, published series of patients describe the clinical, histological, and evolutionary aspects of ScGVHD. Most authors do not separate lichenoid and sclerodermatous cGVHD in their reports, although other authors, 7,8 like us, have found that the lichenoid and sclerodermatous phases of cGVHD occur independently and may be qualitatively different immunopathologic processes. 9 Master et al 1 0 first described ScGVHD in 1975 as sclerodermatous changes in cGVHD.…”

“…4,8 Only Chosidow et al 2,27 reported that 29% of their patients presented with atrophic, pearly white plaques. We have found lichen sclerosus-like lesions in 8 (47%) of our patients and, in the 3 of these patients undergoing biopsy, histological findings of lichen sclerosus were found.…”

Optimal management of chronic graft‐versus‐host disease in children

“…The scalp can develop changes similar to seborrhea. Nails can become brittle, crack, and develop ridging (Andrews et al, 1997). These changes can be permanent in many cases.…”