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Screening skin for chronic GVHD

If skin GVHD (graft-versus-host disease) is suspected, a timely collaboration with the patient's transplant center is recommended to confirm the diagnosis and to develop and evaluate a treatment plan.

Evaluation

Patient-reported symptoms and signs

  • Itching
  • Dry skin
  • Limited mobility
  • Rash
  • Sores
  • Changes in skin coloring or texture
  • Edema

Clinical examination

Complete visual examination of the skin with particular attention to pigmentary changes, rashes, textural changes, tightness, areas of thickening or skin breakdown, ulcers or erosions

Palpation for areas of sclerosis or fasciitis

Diagnostic testing

Skin biopsy

Clinical manifestation

Clinical manifestation
Description

Sweat impairment**

May manifest as heat intolerance due to loss of sweat glands

Ulcer

Localized skin lesion in which the whole of the epidermis and at least part of the dermis has been lost. May extend into the subcutaneous fat

Ichthyosis**

Rough, thick and scaly skin

Hypopigmentation**

Diminished pigmentation of the skin

Hyperpigmentation**

Darkening of the skin due to pigment deposition

Keratosis pilaris**

Pale to erythematous perifollicular papules with spiny keratotic plugs within the follicular openings

Maculopapular rash***

Raised and flat small, red lesions

Erythema***

Abnormal redness of the skin

Pruritus***

Localized or generalized itching

Erosion

Localized skin lesion characterized by complete or partial loss of only the epidermis


* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.

Photo Atlas

This photo atlas contains pictorial representations of various clinical manifestations of chronic GVHD.

  • Poikiloderma

    Poikiloderma

    Hypo- and hyper-pigmentary changes with erythema and atrophy.

  • Morphea

    Morphea-like

    Localized patchy area(s) of moveable smooth or shiny skin with a leather-like waxy or hardened consistency. Note the fibrotic, hypopigmented area in the center of the plaque with a slightly hyperpigmented border.

  • Keratosis

    Keratosis pilaris

    Skin-colored to erythematous perifollicular papules with spiny keratotic plugs within the follicular openings.

  • Lichenoid hands

    Lichen planus-like

    Hyperpigmented/purple papules which may coalesce into annular (ring-like) small plaques. These lesions closely resemble the dermatologic disease lichen planus.

  • Lichen planus

    Lichen planus-like

    Discrete to coalescent gray to white moveable papules or plaques.

  • Lichen sclerosus

    Lichen sclerosus-like

    Close-up showing wrinkled texture and shiny appearance. Lesions tend to be grouped in discrete patches.

  • Hyperpigmentation

    Hyperpigmentation

    Excess pigmentation in the skin; may manifest in a widespread reticulated pattern.

  • Hypopigmentation

    Hypopigmentation, hyperpigmentation, depigmentation, sclerosis

    Diminished (hypo-) or excess (hyper-) pigmentation in the skin. Sclerotic tissue is hard and fibrous, with a decreased ability to pinch. Superficial sclerosis is moveable upon palpation, while deep sclerosis is hidebound and fixed.

  • Sclerosis fascitis

    Sclerosis, fasciitis

    Subcutaneous sclerosis/fasciitis can be detected by a “groove sign” seen here.

  • Sclerosis

    Sclerosis

    Subcutaneous sclerosis can be manifested by rippling, dimpling of the skin and a resultant cellulite-like appearance.

  • Skin erosion

    Erosion

    Localized tissue destruction characterized by complete or partial loss of only the epidermis.

  • Dermatologic

    Maculopapular

    Raised and flat small, red lesions.