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Therapeutic Approach

Graft-versus-host disease (GVHD) is a multisystem consequence of allogenic hematopoietic stem cell transplantation. Acute cutaneous GVHD typically presents 2-4 weeks following transplant and ranges from an asymptomatic exanthem to widespread necrolysis. Chronic GVHD is a polymorphous disease and can be divided into nonsclerotic features—papulosquamous, poikiloderma, lichen planus, lichen sclerosus-like—and sclerotic features—resembling morphea, scleroderma, or eosinophilic fasciitis. Therapy should consider skin disease subtype and other organ activity (eg, ocular, oral, GI, pulmonary disease). First-line treatment is typically systemic corticosteroids. Treatment for steroid-refractory disease is not standardized—only ruxolitinib, ibrutinib, and belumosudil are FDA-indicated for GVHD—and referral to clinical trial should be considered. See Table 125-1.

Table 125-1Cutaneous Graft-Versus-Host Disease Treatment Table

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