Lichenoid Inflammatory Phase of Chronic Skin GVHD
Abstract Editor please note under the affiliation 1 university is misspelled
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.
KeywordsChronic GVHD Lichen planus-like chronic GVHD Inflammatory phase of chronic GVHD Cutaneous GVHD Late-onset of acute GVHD Overlap syndrome with acute and chronic GVHD Lichenoid dermatitis Eosinophilia in chronic GVHD Poikiloderma NIH consensus conferences on cGVHD Nail dystrophy
- 11.Vogelsang GB, Pavletic SZ. Chronic graft versus host disease: interdiciplinary management. New York: Cambridge University Press; 2009.Google Scholar
- 12.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.CrossRefGoogle Scholar
- 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. e381CrossRefGoogle Scholar
- 20.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):1150–63CrossRefGoogle Scholar