Title:Pediatric Cutaneous Graft Versus Host Disease: A Review
Volume: 13
Issue: 2
Author(s): Connie R. Shi, Jennifer T. Huang and Vinod E. Nambudiri*
Affiliation:
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, MA,United States
Keywords:
Graft versus host disease, cutaneous, dermatology, pediatric hematopoietic stem cell transplant, GVHD, HSCT.
Abstract: Background: Graft versus host disease (GVHD) is a significant complication following
hematopoietic stem cell transplantation in the pediatric population. The most common clinical
manifestation of GVHD is in the skin. This article will present a review of key concepts related to
pediatric cutaneous GVHD, including pathophysiology, clinical epidemiology, diagnosis, and
treatment options.
Objective: GVHD is an immune-mediated process characterized by an inflammatory immune
response in acute GVHD and mixed inflammatory and fibrotic states in chronic GVHD. The
clinical presentations of cutaneous GVHD are heterogeneous. Method: Acute cutaneous GVHD
classically presents as an erythematous morbilliform eruption appearing within a few weeks after
transplantation. Chronic cutaneous GVHD may manifest as poikiloderma, lichenoid lesions, or
sclerodermatous changes. The sclerodermatous form of cutaneous GVHD is associated with
substantial long-term morbidity, including joint contractures, myalgias, and mobility restriction.
Results: First-line pharmacologic treatment options typically include corticosteroids and in some
cases, calcineurin inhibitors. Biologics and immunotherapies are an active area of investigation for
GVHD that is refractory to corticosteroid treatment. Non-pharmacologic treatment options that
have shown benefit for cutaneous GVHD include extracorporeal photopheresis and phototherapy.
Conclusion: Accurate diagnosis and treatment of cutaneous GVHD is essential to preventing and
alleviating the long-term sequelae and morbidity associated with this condition.
