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Skin ulcers related to chronic graft‐versus‐host disease: clinical findings and associated morbidity
Author(s) -
Jachiet M.,
Masson A.,
Peffault de Latour R.,
Rybojad M.,
Robin M.,
Bourhis J.H.,
Xhaard A.,
Dhedin N.,
Sicre de Fontbrune F.,
Suarez F.,
Barete S.,
Parquet N.,
Nguyen S.,
Ades L.,
Rubio M.T.,
Wittnebel S.,
Bagot M.,
Socié G.,
Bouaziz J.D.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12828
Subject(s) - saint , medicine , art history , art
Summary Background According to the National Institutes of Health classification of chronic graft‐versus‐host disease (c GVHD ), skin ulcers after allogeneic haematopoietic stem‐cell transplantation (HSCT) are recorded as having the maximal severity score but published data are scarce. Objectives To describe skin ulcers related to c GVHD with an emphasis on clinical findings, associated morbidity, management and evolution. Patients and methods A multicentre retrospective analysis was carried out of patients with a diagnosis of c GVHD skin ulcers. Results All 25 patients included in the study had sclerotic skin c GVHD and 21 had lichenoid skin lesions associated with the sclerotic skin lesions. Thirteen patients had severe c GVHD without considering the skin, because of the involvement of an extracutaneous organ by c GVHD . The median time from HSCT to the onset of ulcers was 44 months. In addition to scleroderma, initial skin lesions at the site of ulcers were bullous erosive lichen in 21 patients and bullous erosive morphoea in four patients. Fifteen patients had an inaugural oedema. Ulcers were mostly bilateral with a predilection for the lower limbs. They were frequently colonized but few infections occurred. Four patients died during a median follow‐up period of 55 months. Conclusions Chronic graft‐versus‐host disease skin ulcers occur in patients with sclerodermatous skin cGVHD , are associated with severe cGVHD , often start with bullous lichenoid lesions or bullous morphoea and seem to cause more morbidity than mortality, given the low rate of mortality observed in our series of patients.