Skin Signs of Graft Versus Host Disease

Graft-Versus-Host Disease (GVHD) is a common complication associated with high mortality that results from the immunologic insult of introducing immunologically competent cells into an immunoincompetent host, which allows these grafted cells to mount a destructive immune response against the recipient tissues. The main cause ofGVHD is allogenic Hematopoietic Cell Transplantation (HCT) although it can also be seen secondary to solid organ transplantation. 

The skin is one of the initial and main organs affected by GVHD in up to 94.2% of patients, and as such, recognizing these dermatologic manifestations represents an important tool for early diagnosis allowing prompt installation of treatment, although an early start to therapy is not always determinant of outcome. Historically, GVHD has been divided into acute GVHD (aGVHD) and chronic GVHD (cGVHD). Acute GVHD describes a distinctive syndrome of dermatitis, bilirubin elevation, and diarrea developing within 100 days of transplantation. Chronic GVHD describes a more diverse syndrome developing after day 100. However, this definition falls short, and in 2005 the National Institutes of Health classification included late-onset acute GVHD (after day 100) and an overlap syndrome with features of both acute and chronic GVHD. Read more>>>>>>>>>>>>>>