We read with interest the report by Creamer et al1 in the September issue of the Archives, which described 10 patients with eczematoid dermatitis that occurred after allogeneic hematopoietic stem cell transplantation. The authors considered this eruption to represent a novel form of chronic cutaneous graft-vs-host disease (GVHD). We have seen several bone marrow transplant recipients who presented with a similar eruption and considered them to have one of the papulosquamous variants of GVHD and not a novel form. The decision to restrict or separate various presentations of a disease may be regarded as “lumping” or “splitting” and is the rationale for classification schemes. Creamer and colleagues suggest that a distinction of this clinical presentation of GVHD is important because all 10 patients developed erythroderma and had substantial associated morbidity and mortality. However, the increased morbidity and mortality might be attributable to the extent of disease (erythroderma) rather than to the presence of eczematous findings that were observed clinically and histologically in these patients. Moreover, the clinical and pathologic findings in this series of patients are more consistent with those designated as acute GVHD, even though Creamer and coauthors' patients had a protracted and “chronic” skin course.
Cook-Norris RH, Weenig RH. Eczematoid Graft-vs-Host Disease. Arch Dermatol. 2008;144(8):1066. doi:10.1001/archderm.144.8.1066-a