Dermatology Consultation for Cutaneous Complications of Hematopoietic Stem Cell Transplantation

Abstract

BackgroundThe acute onset of a skin eruption early in the post-transplant course of the hematopoietic stem cell transplant (HSCT) patient is challenging due to the clinical similarity of eruptions that are common in this population. These include of morbilliform drug eruptions, viral exanthema, eruption of lymphocyte recovery, erythema multiforme, toxic erythema of chemotherapy, and acute graft-versus-host disease (GVHD). We aimed to identify cutaneous eruptions in HSCT patients in the early post-transplant period, and the incidence of dermatologic consultation, along with the utility of skin biopsies and whether a change in management resulted from the consultation.MethodsA retrospective chart review was performed on patients at Northwestern Memorial Hospital who underwent their first allogenic or autologous HSCT in 2009. Information collected included incidence and presentation of cutaneous complications (including GVHD), as well as frequency and outcome of dermatologic consultation (including changes in patient management as a result of consultation).ResultsWe found 220 patients who received a HSCT in 2009. To date, 126 (80 autologous, 46 allogeneic) of these have been analyzed. Preliminary data shows that 50/126 (39.7%) patients had cutaneous complications in the early post-transplant period, and of these, 21/50 (42.0%) were diagnosed with acute GVHD. Dermatology was consulted for 29/50 (58.0%) patients with rash and a skin biopsy was perfomed on 16/29 (55%) patients seen by dermatology. Treatment plans were changed after dermatologic consultation in 15/29 (51.7%) patients.ConclusionDermatologic consultation for the recognition and diagnosis of the early cutaneous complications of HSCT is a valuable resource that often leads to changes in patient management. Further studies are necessary to analyze whether patient outcomes are affected by dermatologic consultation. BackgroundThe acute onset of a skin eruption early in the post-transplant course of the hematopoietic stem cell transplant (HSCT) patient is challenging due to the clinical similarity of eruptions that are common in this population. These include of morbilliform drug eruptions, viral exanthema, eruption of lymphocyte recovery, erythema multiforme, toxic erythema of chemotherapy, and acute graft-versus-host disease (GVHD). We aimed to identify cutaneous eruptions in HSCT patients in the early post-transplant period, and the incidence of dermatologic consultation, along with the utility of skin biopsies and whether a change in management resulted from the consultation. The acute onset of a skin eruption early in the post-transplant course of the hematopoietic stem cell transplant (HSCT) patient is challenging due to the clinical similarity of eruptions that are common in this population. These include of morbilliform drug eruptions, viral exanthema, eruption of lymphocyte recovery, erythema multiforme, toxic erythema of chemotherapy, and acute graft-versus-host disease (GVHD). We aimed to identify cutaneous eruptions in HSCT patients in the early post-transplant period, and the incidence of dermatologic consultation, along with the utility of skin biopsies and whether a change in management resulted from the consultation. MethodsA retrospective chart review was performed on patients at Northwestern Memorial Hospital who underwent their first allogenic or autologous HSCT in 2009. Information collected included incidence and presentation of cutaneous complications (including GVHD), as well as frequency and outcome of dermatologic consultation (including changes in patient management as a result of consultation). A retrospective chart review was performed on patients at Northwestern Memorial Hospital who underwent their first allogenic or autologous HSCT in 2009. Information collected included incidence and presentation of cutaneous complications (including GVHD), as well as frequency and outcome of dermatologic consultation (including changes in patient management as a result of consultation). ResultsWe found 220 patients who received a HSCT in 2009. To date, 126 (80 autologous, 46 allogeneic) of these have been analyzed. Preliminary data shows that 50/126 (39.7%) patients had cutaneous complications in the early post-transplant period, and of these, 21/50 (42.0%) were diagnosed with acute GVHD. Dermatology was consulted for 29/50 (58.0%) patients with rash and a skin biopsy was perfomed on 16/29 (55%) patients seen by dermatology. Treatment plans were changed after dermatologic consultation in 15/29 (51.7%) patients. We found 220 patients who received a HSCT in 2009. To date, 126 (80 autologous, 46 allogeneic) of these have been analyzed. Preliminary data shows that 50/126 (39.7%) patients had cutaneous complications in the early post-transplant period, and of these, 21/50 (42.0%) were diagnosed with acute GVHD. Dermatology was consulted for 29/50 (58.0%) patients with rash and a skin biopsy was perfomed on 16/29 (55%) patients seen by dermatology. Treatment plans were changed after dermatologic consultation in 15/29 (51.7%) patients. ConclusionDermatologic consultation for the recognition and diagnosis of the early cutaneous complications of HSCT is a valuable resource that often leads to changes in patient management. Further studies are necessary to analyze whether patient outcomes are affected by dermatologic consultation. Dermatologic consultation for the recognition and diagnosis of the early cutaneous complications of HSCT is a valuable resource that often leads to changes in patient management. Further studies are necessary to analyze whether patient outcomes are affected by dermatologic consultation.