RT Book, Section A1 Martires, Kathryn J. A1 Cowen, Edward W. A2 Kang, Sewon A2 Amagai, Masayuki A2 Bruckner, Anna L. A2 Enk, Alexander H. A2 Margolis, David J. A2 McMichael, Amy J. A2 Orringer, Jeffrey S. SR Print(0) ID 1161338947 T1 Graft-Versus-Host Disease T2 Fitzpatrick's Dermatology, 9e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9780071837798 LK dermatology.mhmedical.com/content.aspx?aid=1161338947 RD 2024/10/07 AB AT-A-GLANCEAcute graft-versus-host disease (GVHD) is a serious and potentially life-threatening sequelae of allogeneic hematopoietic stem cell transplantation. Skin manifestations range from a mild, asymptomatic morbilliform eruption to full-thickness skin loss resembling toxic epidermal necrolysis. Hepatic involvement is characterized by elevated total bilirubin. GI disease manifests as abdominal pain, nausea/vomiting, and secretory diarrhea.The most important risk factor for chronic GVHD is a history of acute GVHD. Other important factors include human leukocyte antigen incompatibility, older age, female donor/male recipient, and peripheral blood stem cell source (vs bone marrow).Chronic GVHD of the skin may resemble lichen planus, lichen sclerosus, morphea, systemic sclerosis, or eosinophilic fasciitis. The presentation can be remarkably variable, however, and may resemble folliculitis, keratosis pilaris, or psoriasis. Both epidermal and sclerotic skin manifestations may present at sites of trauma.Patients with chronic GVHD may manifest other autoimmune skin diseases, such as vitiligo and alopecia areata.The pathogenesis of chronic GVHD is poorly understood and nearly every organ system is at risk. The skin, oral mucosa, eyes, GI tract, and lungs are most frequently involved. In many cases, organ system disease resembles known autoimmune conditions.Topical steroids and topical calcineurin inhibitors are used to treat mild, skin-limited chronic GVHD, and systemic steroids are first line in the treatment of moderate to severe chronic GVHD.Optimal dermatologic management of chronic GVHD of the skin requires an understanding of other organ involvement, infection status, and cancer relapse risk. Close communication with the transplantation physician and a “team approach” to multispecialty management is needed.