RT Book, Section
A1 Cowen, Edward W.
A2 Goldsmith, Lowell A.
A2 Katz, Stephen I.
A2 Gilchrest, Barbara A.
A2 Paller, Amy S.
A2 Leffell, David J.
A2 Wolff, Klaus
SR Print(0)
ID 56028959
T1 Chapter 28. Graft-versus-Host Disease
T2 Fitzpatrick's Dermatology in General Medicine, 8e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-166904-7
LK accessmedicine.mhmedical.com/content.aspx?aid=56028959
RD 2024/04/19
AB |PrintGraft‐versus-Host  Disease  at  a  GlanceAcute  graft-versus-host  disease  (GVHD)  is  a  serious  and  potentially  life-threatening  sequelae  of  allogeneic  hematopoietic  stem  cell  transplantation.  Skin  manifestations  range  from  a  mild,  asymptomatic  exanthem-like  eruption  to  full-thickness  skin  loss  resembling  toxic  epidermal  necrolysis.  Hepatic  involvement  is  characterized  by  elevated  total  bilirubin.  Gastrointestinal  disease  manifests  as  abdominal  pain,  nausea/vomiting,  and  secretory  diarrhea.The  most  important  risk  factor  for  chronic  GVHD  is  a  history  of  acute  GVHD.  Traditionally,  acute  features  present  prior  to  day  100  posttransplantation,  and  chronic  manifestations  after  100  days;  however,  overlap  between  “classic”  acute  and  chronic  features  may  occur.Chronic  GVHD  of  the  skin  is  remarkably  variable  in  clinical  presentation.  Epidermal  involvement  may  resemble  lichen  planus,  keratosis  pilaris,  or  psoriasis.  Sclerotic  changes  may  resemble  lichen  sclerosus,  morphea,  systemic  sclerosis,  or  eosinophilic  fasciitis.The  pathogenesis  of  chronic  GVHD  is  poorly  understood  and  nearly  every  organ  system  is  at  risk.  The  skin,  oral  mucosa  eyes,  gastrointestinal  tract,  and  lungs  are  most  frequently  involved.  In  many  cases,  organ  system  disease  resembles  known  autoimmune  conditions.Optimal  dermatologic  management  of  chronic  GVHD  of  the  skin  requires  an  understanding  of  other  organ  involvement,  infection  status,  and  cancer  relapse  risk.  Close  communication  with  the  transplant  physician  and  a  “team  approach”  to  multispecialty  management  is  needed.