Graft-vs-host disease (GVHD) occurs in some patients after bone-marrow transplantation (BMT).
Also called stem cell transplantation, BMT is a procedure in which blood stem cells are removed from a donor and inserted into a host patient to create different blood cells and a new host immune system. It is reserved for severe, life-threatening medical conditions. The most important danger of BMT is GVHD. This occurs when the transplanted cells attack normal organs in the host. Acute GVHD usually occurs within the first few months after transplantation, but chronic GVHD can occur several months or even years after BMT.
Acute GVHD causes a red skin rash, diarrhea, and/or liver problems. Acute GVHD often starts on the palms, soles, or face, but it may spread to the entire body and can sometimes be severe enough that blistering of the skin may occur.
Chronic GVHD can cause damage to many different organs. Common problems are dry and irritated eyes, dryness and sores in the mouth, and skin rashes. Chronic GVHD of the skin can cause color changes (red, pink, purple, brown, or white), skin thinning or thickening or hardening, rashes, scaly areas, bumps, sores, or blisters. The skin may itch, feel like sunburn, or feel “tight” and “woody” like a stick.
Chronic GVHD can affect the skin anywhere on the body and also damage the hair and nails. Patients may lose their hair. The nails may become more fragile and split or break more easily. In addition, involvement of the genital skin may cause pain and scarring and interfere with sexual function.
Sclerotic chronic GVHD is a specific type of skin problem in which there is thickening, tightness, and hardening of the skin and deeper tissues. This can also make it hard to move the joints. It is more common on arms, legs, lower belly, and lower back, but it can occur anywhere. Sclerotic chronic GVHD may also cause skin sores (ulcers) to heal slowly. Ulcers are more common on the legs.
A skin biopsy may be necessary to confirm a diagnosis of chronic GVHD but is not always needed.
Treatment for skin GVHD is challenging, often requiring several types of therapy, and usually involves both a dermatologist and the BMT physician. When there is skin thickening, physical therapy is important to keep the joints mobile. Topical steroid creams and other topical drugs may decrease pain and itching. Specialized wound care dressings may be helpful to heal open ulcers. Ultraviolet (UV) light (phototherapy) may also be used. In this treatment, patients are treated in a doctor’s office with a special UV light that helps to calm skin inflammation. Extracorporeal photopheresis also uses UV light to treat GVHD but is performed directly on the patient’s blood.
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Conflict of Interest Disclosures: None reported.
Cowen EW. Graft-vs-Host Disease. JAMA Dermatol. 2016;152(3):356. doi:10.1001/jamadermatol.2015.5659