Chronic graft-versus-host disease in Adult
Cutaneous GVHD has both an acute and a chronic form. Acute GVHD normally occurs within 2-4 weeks of stem cell infusion and typically presents as a morbilliform eruption that may progress to erythroderma or, rarely, a toxic epidermal necrolysis-like picture.
Chronic cutaneous GVHD usually presents a mean of 4 months after transplantation with mucocutaneous manifestations. The incidence of chronic GVHD is estimated to be 60%-70% in recipients of allogeneic stem cell transplants with mismatched and unrelated donors, and about 30% in recipients of fully histocompatible sibling donor transplants. Chronic GVHD can occasionally be triggered by exposure to UV light, physical trauma, herpes zoster, or Borrelia infections. Almost all chronic GVHD patients will have skin involvement. Oral mucosal, hepatic, and ocular involvement is also quite common. Chronic GVHD increases the overall risk of systemic and recurrent bacterial infections.
GVHD is a major source of morbidity and mortality among transplant recipients. The risk of developing chronic GVHD increases with advancing age, prior acute GVHD, history of splenectomy, and donor or recipient cytomegalovirus seropositivity. On the other hand, chronic GVHD is associated with beneficial graft-versus-tumor effects and reduced risk of leukemia relapse, especially with more severe chronic GVHD.
D89.811 – Chronic graft-versus-host disease
402356004 – Chronic graft-versus-host disease
- Lichen planus
- Lichenoid drug eruption
- Lichen sclerosus
- Nephrogenic systemic fibrosis
- Postinflammatory hyperpigmentation
- Postinflammatory hypopigmentation
- Keratosis pilaris
- Fasciitis from chronic musculoskeletal GVHD (can be difficult to distinguish from sclerodermatous chronic GVHD and may require MRI to diagnose)