The clinical and histologic spectrum of chronic graft-versus-host disease

Abstract

To the Editor: We were happy to read the article by Schaffer et al1Schaffer J.V. McNiff J.M. Seropian S. Cooper D.L. Bolognia J.L. Lichen sclerosus and eosinophilic fasciitis as manifestations of chronic graft-versus-host disease: expanding the sclerodermoid spectrum.J Am Acad Dermatol. 2005; 53: 591-601Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar; they cited our article2Peñas P.F. Jones-Caballero M. Aragües M. Fernández-Herrera J. Fraga J. García-Diez A. Sclerodermatous graft-vs-host disease: clinical and pathological study of 17 patients.Arch Dermatol. 2002; 138: 924-934Crossref PubMed Google Scholar regarding the presence of lichen sclerosus lesions in patients with cutaneous chronic graft-versus-host disease (cGVHD). In our article we described, clinically and histopathologically, lesions of lichen sclerosus, morphea, panniculitis, and fasciitis in 17 patients with cGVHD. Schaffer et al suggest that sclerodermoid involvement in cGVHD includes lichen sclerosus, morphea, and eosinophilic fasciitis. We would like to further expand the spectrum of sclerodermoid involvement in cGVHD by adding subcutaneous tissue involvement. In our article, we described 6 cases of septal panniculitis together with deep dermal sclerosis and another patient with septal fibrosis. Clinically, all these patients presented with rippled or puckered skin.2Peñas P.F. Jones-Caballero M. Aragües M. Fernández-Herrera J. Fraga J. García-Diez A. Sclerodermatous graft-vs-host disease: clinical and pathological study of 17 patients.Arch Dermatol. 2002; 138: 924-934Crossref PubMed Google Scholar Janin et al,3Janin A. Socie G. Devergie A. Aractingi S. Esperou H. Verola O. et al.Fasciitis in chronic graft-versus-host disease. A clinicopathologic study of 14 cases.Ann Intern Med. 1994; 120: 993-998Crossref PubMed Scopus (112) Google Scholar who described eosinophilic fasciitis in patients with cGVHD, described septal infiltration in their patients. Shaffer et al1Schaffer J.V. McNiff J.M. Seropian S. Cooper D.L. Bolognia J.L. Lichen sclerosus and eosinophilic fasciitis as manifestations of chronic graft-versus-host disease: expanding the sclerodermoid spectrum.J Am Acad Dermatol. 2005; 53: 591-601Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar described septal involvement in one case of eosinophilic fasciitis that also presented lesions of lichen sclerosus. Our article suggested that sclerodermoid cGVHD can start in any level of the skin and extend to involve the complete dermis, the subcutaneous tissue, and the fascia. This is graphically represented in Fig 1, which shows the spectrum of cutaneous cGVHD, reflecting the anatomic levels of involvement.