The letters from Reisfeld and Wilson and Lockman both favor the hypothesis that the linear or dermatomal pattern of lichenoid chronic graft-vs-host disease (GVHD) corresponds to Blaschko's lines rather than a relationship to herpes zoster virus infection as proposed in our article.1 While both of these hypotheses remain unproven, there are several points that favor the relationship to herpes zoster virus infection.
The basic argument Dr Reisfeld is raising is that mosaicism within the skin causes differences in minor antigen expression that are recognized by donor lymphocytes resulting in GVHD in a linear distribution. If this were the only explanation, several clinical events would have been expected: (1) acute GVHD should have at least started in the same linear distribution before becoming confluent, and (2) chronic GVHD should have at least started in the same linear distribution.
Neither of the above was true for the patients reported,1 including the
Farmer ER, Vogelsang GB. Lichenoid Chronic Graft-vs-Host Disease-Reply. Arch Dermatol. 1994;130(9):1208. doi:10.1001/archderm.1994.01690090142026