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Review
. 2018 Feb;19(1):33-50.
doi: 10.1007/s40257-017-0306-9.

Cutaneous Graft-Versus-Host Disease: Diagnosis and Treatment

Karla Strong Rodrigues  1 , Carla Oliveira-Ribeiro  1 , Silvia de Abreu Fiuza Gomes  2 , Robert Knobler  3
Affiliations
Review

Cutaneous Graft-Versus-Host Disease: Diagnosis and Treatment

Karla Strong Rodrigues et al. Am J Clin Dermatol. 2018 Feb.

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.

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Conflict of interest statement

Fusnding

No financial support was received for this study or the preparation of this article.

Conflict of interest

Robert Knobler is a consultant to Mallinckrodt-Therakos, a company specialising in extracorporeal photopheresis systems, used in the treatment of graft-versus-host disease. Karla Strong Rodrigues, Carla Oliveira-Ribeiro, and Silvia de Abreu Fiuza Gomes declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Acute cutaneous graft-versus-host disease. a Maculopapular rash; b erythroderma
Fig. 2
Fig. 2
Acute cutaneous graft-versus-host disease affecting the palms
Fig. 3
Fig. 3
Acute cutaneous GVHD. a Blisters; b complete detachment of the epidermis in acute GVHD mimicking toxic epidermal necrolysis. GVHD graft-versus-host disease
Fig. 4
Fig. 4
Chronic cutaneous graft-versus-host disease. a–c Lichen planus-like lesions
Fig. 5
Fig. 5
Dyshidrosis-like lesions in chronic cutaneous graft-versus-host disease
Fig. 6
Fig. 6
White arboriform lines resembling oral lichen planus in chronic cutaneous graft-versus-host disease
Fig. 7
Fig. 7
Chronic cutaneous graft-versus-host disease lesions resembling pityriasis rosea
Fig. 8
Fig. 8
Chronic cutaneous graft-versus-host disease. a Morphea-like eruption; b localized sclerotic lesion
Fig. 9
Fig. 9
Diffuse sclerosis with ulcer in chronic cutaneous graft-versus-host disease
See this image and copyright information in PMC

References

    1. Atkinson K, Horowitz MM, Gale RP, van Bekkum DW, Gluckman E, Good RA, et al. Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation. Blood. 1990;75(12):2459–2464. - PubMed
    1. Jagasia M, Arora M, Flowers ME, Chao NJ, McCarthy PL, Cutler CS, et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012;119(1):296–307. doi: 10.1182/blood-2011-06-364265. - DOI - PMC - PubMed
    1. Molaro GL, De Angelis V. Graft versus host disease after transfusion of blood and its products [in Italian] Riv Emoter Immunoematol. 1984;31(2):107–123. - PubMed
    1. Murali AR, Chandra S, Stewart Z, Blazar BR, Farooq U, Ince MN, et al. Graft versus host disease after liver transplantation in adults: a case series, review of literature, and an approach to management. Transplantation. 2016;100(12):2661–2670. doi: 10.1097/TP.0000000000001406. - DOI - PMC - PubMed
    1. Fidler C, Klumpp T, Mangan K, Martin M, Sharma M, Emmons R, et al. Spontaneous graft versus host disease occurring in a patient with multiple myeloma after autologous stem cell transplant. Am J Hematol. 2012;87(2):219–221. doi: 10.1002/ajh.22227. - DOI - PubMed

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