Graft-versus-host reaction. Cutaneous manifestations following bone marrow transplantation

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Abstract
Distinctive cutaneous changes that occur in acute and chronic forms of graft-vs.-host reaction (GVHR) are described in 2 living patients in whom GVHR developed after bone marrow transplantation for aplastic anemia. In the skin, the mild form of the acute GVHR is recognized as a subtle macular erythema and the severe form appears as erythematous papules and violaceous macules with scale. Skin biopsy specimens in both acute forms show vacuolar alterations of the epidermal basal-cell layer with a perivenular infiltrate of lymphocytes. Chronic GVHR evolves from generalized scaling to diffuse areas of sclerotic and atrophic skin with a curious reticulated hyperpigmentation, ulcerations and alopecia. Histopathologic study shows collagenization of the dermis that can be correlated with the clinical sclerodermoid changes. Owing to its visibility, the skin offers a unique opportunity for early recognition of the GVHR.

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