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Cutaneous chronic graft-versus-host disease (cGVHD) exhibits a variety of different appearances and phases. Most commonly, cGVHD presents with generalized lichen planus-like involvement of the skin, although other skin diseases are also mimicked. Cutaneous cGVHD begins as a generalized inflammatory stage and gradually develops into a sclerodermatous phase. These changes are not uniform, and one may see various phases of the disease in different parts of the body. Lichenoid or inflammatory cGVHD is recognized by an acanthotic hyperkeratotic epidermis with shortened sawtoothed shaped rete ridges, by a band-like lymphocytic infiltrate within the superficial dermis, with accompanying destruction of dermal appendages, including the hair follicles and eccrine ducts. Late-onset acute graft-versus-host disease (aGVHD) occurs when there are superimposed changes of aGVHD in the skin and gut that coexist with changes of cGVHD. Lichenoid cGVHD evolves from an inflammatory phase to poikiloderma with various degrees of dermal atrophy, dyspigmentation and sclerosis. Skin biopsies should include the deep dermis and subcutaneous fat to assess for paniculitis. Confirmatory skin biopsies for cGVHD are necessary if there are no other stigmata of cGVHD in other organs.
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Jacobsohn DA, Montross S, Anders V, Vogelsang GB. Clinical importance of confirming or excluding the diagnosis of chronic graft-versus-host disease. Bone Marrow Transplant. 2001;28(11):1047–51.
Bolanos-Meade J, Anders V, Wisell J, Farmer ER, Vogelsang GB. Grover’s disease after bone marrow transplantation. Biol Blood Marrow Transplant. 2007;13(9):1116–7.
Marra DE, McKee PH, Nghiem P. Tissue eosinophils and the perils of using skin biopsy specimens to distinguish between drug hypersensitivity and cutaneous graft-versus-host disease. J Am Acad Dermatol. 2004;51(4):543–6.
Inamoto Y, Storer BE, Petersdorf EW, et al. Incidence, risk factors, and outcomes of sclerosis in patients with chronic graft-versus-host disease. Blood. 2013;121(25):5098–103.
Sharon VR, Konia TH, Barr KL, Fung MA. Assessment of the ‘no eosinophils’ rule: are eosinophils truly absent in pityriasis lichenoides, connective tissue disease, and graft-vs.-host disease? J Cutan Pathol. 2012;39(4):413–8.
Park JH, Lester L, Kim J, Kwong BY. Acral verruca-like presentation of chronic graft-vs.-host disease. J Cutan Pathol. 2016;43(3):236–41.
Cornejo CM, Kim EJ, Rosenbach M, Micheletti RG. Atypical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2015;72(4):690–5.
Kavand S, Lehman JS, Hashmi S, Gibson LE, El-Azhary RA. Cutaneous manifestations of graft-versus-host disease: role of the dermatologist. Int J Dermatol. 2017;56(2):131–40.
Ziemer M. Graft-versus-host disease of the skin and adjacent mucous membranes. J Dtsch Dermatol Ges. 2013;11(6):477–95.
Hymes SR, Alousi AM, Cowen EW. Graft-versus-host disease: part I. Pathogenesis and clinical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2012;66(4):515 e511–8. quiz 533-514
Vogelsang GB, Pavletic SZ. Chronic graft versus host disease: interdiciplinary management. New York: Cambridge University Press; 2009.
Cooke KR, Luznik L, Sarantopoulos S, et al. The biology of chronic graft-versus-host disease: a task force report from the National Institutes of Health Consensus Development Project on Criteria for clinical trials in chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2017;23(2):211–34.
Lee SJ. Classification systems for chronic graft-versus-host disease. Blood. 2017;129(1):30–7.
Flowers ME, Martin PJ. How we treat chronic graft-versus-host disease. Blood. 2015;125(4):606–15.
Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant. 2015;21(3):389–401. e381
Holtan SG, Khera N, Levine JE, et al. Late acute graft-versus-host disease: a prospective analysis of clinical outcomes and circulating angiogenic factors. Blood. 2016;128(19):2350–8.
Arora M, Cutler CS, Jagasia MH, et al. Late acute and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22(3):449–55.
Omer AK, Weisdorf DJ, Lazaryan A, et al. Late acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2016;22(5):879–83.
Bruggen MC, Klein I, Greinix H, et al. Diverse T-cell responses characterize the different manifestations of cutaneous graft-versus-host disease. Blood. 2014;123(2):290–9.
Paul J. Martin, J. Douglas Rizzo, John R. Wingard, Karen Ballen, Peter T. Curtin, Corey Cutler, Mark R. Litzow, Yago Nieto, Bipin N. Savani, Jeffrey R. Schriber, Paul J. Shaughnessy, Donna A. Wall, Paul A. Carpenter, (2012) First- and Second-Line Systemic Treatment of Acute Graft-versus-Host Disease: Recommendations of the American Society of Blood and Marrow Transplantation. Biology of Blood and Marrow Transplantation 18 (8):1150–63
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Chang, O.H., Perrone, M.E., Robin, A.J., Shulman, H.M. (2019). Lichenoid Inflammatory Phase of Chronic Skin GVHD. In: Yeung, C., Shulman, H. (eds) Pathology of Graft vs. Host Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-42099-8_6
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DOI: https://doi.org/10.1007/978-3-319-42099-8_6
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