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Chronic graft-versus-host disease - Nail and Distal Digit
See also in: Overview,Oral Mucosal Lesion
Other Resources UpToDate PubMed

Chronic graft-versus-host disease - Nail and Distal Digit

See also in: Overview,Oral Mucosal Lesion
Contributors: Shari Lipner MD, PhD, Philip I. Song MD, Ivy Lee MD, Jonathan Cotliar MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Graft-versus-host disease (GVHD) is a T-cell-mediated inflammatory disorder that occurs after allogenic hematopoietic cell (bone marrow) transplantation, which usually affects the skin, mucosa, conjunctiva, gastrointestinal tract, genital mucosa, liver, and lungs. Immunoactive T-cells from the donated marrow (graft) attack "foreign" antigens in the marrow recipient (host).

Multiple nail findings can be seen in both the acute and chronic forms of GVHD; findings in the chronic form are more common. Acute GVHD is associated with periungual erythema or a violaceous hue of the surrounding tissues; onychomadesis is also possible. Nail alterations occur in 17%-63% of patients with chronic GVHD, and other skin findings are commonly seen. Nail changes in chronic GVHD usually involve scarring of the nail bed and matrix. Fingernails and toenails may both be affected, but fingernails are affected more often. The most common nail finding is longitudinal ridging with nail alterations typically resembling the nail changes seen in lichen planus.

Most studies show that the presence or absence of nail alterations is not predicted by the clinical severity of GVHD in the adult population. However, a higher incidence and severity of nail changes has been reported to occur in patients with a longer duration of disease. Nail changes are not considered when staging or grading GVHD. In one study, patients with chronic GVHD with hair and nail changes were significantly more likely to have involvement of the oral mucosa and eyes compared to controls.

The presence of nail dystrophy was associated with lower quality of life and higher overall severity of the disease in the pediatric population in one study. 

Codes

ICD10CM:
D89.811 – Chronic graft-versus-host disease

SNOMEDCT:
402356004 – Chronic graft-versus-host disease

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnoses for chronic GVHD include:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:07/10/2020
Last Updated:07/10/2020
Copyright © 2021 VisualDx®. All rights reserved.
Chronic graft-versus-host disease - Nail and Distal Digit
See also in: Overview,Oral Mucosal Lesion
Chronic graft-versus-host disease : Alkaline phosphatase elevated, ALT elevated, AST elevated, Lower extremity edema, Oral white plaque, Arthralgia, Dry eyes, Dry mouth, Hardened skin, Scaly plaques
Clinical image of Chronic graft-versus-host disease
Sclerodactyly with some pink, scaly, and eroded plaques on the fingertips. Note the thinned thumbnail and scattered hyperkeratotic papules on the palm.
Copyright © 2021 VisualDx®. All rights reserved.