Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury: potential insight into the mechanism of isomorphic and isotopic responses

Abstract

Background: The mechanisms responsible for the variable manifestations of chronic cutaneous graft-vs-host disease (cGVHD) are poorly understood. Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury (isomorphic and isotopic responses), a recognized phenomenon in morphea, suggests a potential common pathway between cGVHD and other sclerotic skin conditions.

Observations: Four cases of sclerotic-type cGVHD developed at the site of disparate skin injuries (ionizing radiotherapy, repeated needle sticks, central catheter site, and varicella-zoster virus infection). We review the spectrum of previously reported cases of sclerotic and nonsclerotic cGVHD relating to external forces on the skin.

Conclusions: Localization of sclerotic-type cGVHD may occur after many types of skin injury, including UV and ionizing radiotherapy, needle sticks, viral infection, and pressure or friction. Recognition of this phenomenon may be helpful for the early diagnosis of sclerotic disease. Recent insights into the immunological consequences of minor skin injury may provide important clues to the underlying pathogenesis of cGVHD-mediated skin disease.

Figure 1.

Sclerotic plaque localized to right side of the neck at the site of a previous subclavian venous catheter placement.

Figure 2.

Morphealike chronic cutaneous graft-vs-host disease with a fibrous band at site of multiple previous needle sticks in the right antecubital fossa.

Figure 3.

Localization of morphealike chronic cutaneous graft-vs-host disease to the distribution of a previous varicella-zoster virus infection.

Figure 4.

Isoradiotopic response in chronic cutaneous graft-vs-host disease presenting as a well-circumscribed plaque confined to the field of previous radiotherapy of the left distal femur.