Abstract
A 48-year-old woman had undergone allogeneic SCT for B-cell CLL. GVHD prophylaxis comprised cyclosporine, mycopenolate mofetil and prednisolone for 3 months. Cutaneous chronic GVHD involving the face appeared a year after HSCT with scaling, reddish, pruritic plaques in the seborrhoic areas (Figure 1a). No other areas of the skin, mucosa or nails were affected. The differential diagnosis included eczema, seborrhoic dermatitis, and fungal and bacterial infections. A punch biopsy of the affected skin showed lichenoid chronic GVHD. Histologically, there was partial epidermal atrophy with hyperkeratosis and hypergranulosis. There was focal vacuolar alteration of the basal layer with individual necrotic keratinocytes with eosinophilic cytoplasm without pyknotic nuclei (bolloid bodies) in the epidermal layer. Below these changes, there was a focal lichenoid-organized lymphohistiocytic infiltration with melanophages. Abdominal ultrasound and laboratory investigations (including electrolytes, complete blood count, liver enzymes and renal function) were normal. Given the history and clinical findings, the chronic GVHD was diagnosed.
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