Cutaneous Manifestations of Chronic Graft-versus-Host Disease

Early cGVHD with abrupt onset xerosis and follicular prominence in an annular distribution (rectangle) and small follicular papules (arrows).

Early cGVHD with the new onset of ichthyosis (fish-like scaling).

Early cGVHD presenting with new onset of a keratosis pilaris-like eruption (perifollicular papules with a central core marked by arrow).

Psoriasiform GVHD. Note the well-defined plaques with silvery scaling.

a, Lichen planus-like GVHD presenting with individual and confluent purple polygonal plaques. b, Confluent purple and atrophic white plaques. The thin, hypopigmented, wrinkled, atrophic plaques (circles) are characteristic of lichen sclerosis and the purple plaques on the shoulder with lichen planus. c, Chronic GVHD presenting with linear lichenoid papules. This patient had more typical lichen planus-like lesions elsewhere.

Chronic GVHD presenting as an annular reactive erythema resembling erythema annulare centrifugum. Note the bullous lesion that showed histologic evidence of epidermal necrosis.

Chronic GVHD presenting as erythroderma (confluent erythematous plaques). The initial lesions, as seen on the periphery, were annular.

a, Chronic GVHD presenting as acral erythema with deep-seated vesicles. b, Chronic GVHD presenting as painful palmer erythema and edema.

a, Chronic GVHD presenting with a rash in a “butterfly” malar distribution. These lesions are poikilodermatous, showing hyper- and hypopigmentation, atrophy, and telangiectasia. b, Chronic GVHD presenting with erythema over the metacarpal interphalangeal, proximal interphalangeal and distal interphalangeal joints.

Band-like deep dermal sclerosis presenting in a linear pattern.

a, Sclerosis of the dermis and subcutaneous tissue producing “pipestem” legs with overlying erosions. b, Benign angiomatous (vascular) lesions appearing as a blue-black nodule in a patient with severe dermal sclerosis and resolving bullous changes with residual crusts. Biopsy may be necessary to establish the diagnosis and rule out a skin cancer. c, “Groove” sign (arrows) produced by fibrosis around tendons. d, Rippling and “cellulite” appearance in the axillae produced by subcutaneous septal fibrosis.

a, Sclerosis of the dermis and subcutaneous tissue producing “pipestem” legs with overlying erosions. b, Benign angiomatous (vascular) lesions appearing as a blue-black nodule in a patient with severe dermal sclerosis and resolving bullous changes with residual crusts. Biopsy may be necessary to establish the diagnosis and rule out a skin cancer. c, “Groove” sign (arrows) produced by fibrosis around tendons. d, Rippling and “cellulite” appearance in the axillae produced by subcutaneous septal fibrosis.

Positive “prayer” sign (acute limitation of wrist dorsiflexion) in a patient with fasciitis. This patient also has dermal sclerosis with dyspigmentation, a facial eruption in a butterfly distribution, and lichen planus-like lesions near the elbow. Her antinuclear antibody was positive at 1:640.

Nail loss in cGVHD, with periungual and nail bed changes.

a, Typical Wickham striae, a network of fine lines, are seen on the lips of this patient with cGVHD. b, Erosive mucositis in cGVHD. c, Adherent white nondetachable plaques on the tongue in cGVHD. d, Chronic GVHD of the tongue complicated by documented papilloma virus and biopsy proven squamous cell carcinoma.