Skin manifestations and treatment of graft-versus-host disease

Abstract

Graft-versus-host disease (GVHD) is an autoimmune disease caused by graft-versus-host reaction, occurring most frequently in patients receiving allogeneic hematopoietic stem cell transplantation and occasionally in patients receiving organ transplantation. It often involves multiple organ systems, of which, skin and mucous membranes are the most frequently affected system with various clinical manifestations. Acute GVHD often appears as measles- or scarlet fever-like skin rashes with severe systemic symptoms such as fever and poor appetite, and may rapidly progress into toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) in a few days. Lichen planus and sclerodermoid lesions are the most common clinical manifestations of chronic GVHD. With further understanding of this disease in recent years, some new manifestations have been observed, such as psoriasis- and atopic dermatitis-like skin lesions, as well as nail changes in some cases. It is especially important to select appropriate treatment protocols according to clinical manifestations. Glucocorticoids combined with immunosuppressive agents are a conventional treatment for GVHD, and innovative treatments have emerged with the development of therapeutics. Key words: Graft vs host disease; Skin manifestations; Clinical protocols; Biological agents; Mesenchymal stem cell transplantation