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Background/ObjectivesAcute graft‐versus‐host disease (aGVHD) is a serious condition after allogeneic hematopoietic stem cell transplantation (HSCT), frequently involving skin, gut, and liver. It can be difficult to diagnose early, yet this is vital for adequate management. We sought to identify initial clinical and histopathological features in children with suspected GVHD and the association with clinical course and outcomes.MethodsRetrospective study of patients with skin biopsies for suspected aGVHD from 2006 to 2016. We collected demographic and clinical information, histologic, and immunohistochemical (IHC) findings, and outcomes during follow‐up. Bivariate and multivariate analyses were done to identify risk factors associated with remission, development of severe/life‐threatening aGVHD, and mortality.ResultsWe included 42 patients, 15 females. Skin manifestations occurred 51 days (median) after HSCT. On biopsy, 76.2% had mild (stage 1‐2) skin aGVHD; during the course of the disease, severity and systemic involvement increased to global grade III/IV in 66.6%. All patients received treatment; 15 are in remission from aGVHD and 23 have died. Histologic features were diagnostic in 83.3%. On bivariate and multivariate analysis, we identified initial clinical and histologic findings that were associated with the measured outcomes: odds of remission from aGVHD were increased when focal vacuolar changes were found on skin biopsy (OR 6.028; 95%CI:1.253‐28.992) but decreased by initial hepatic aGVHD (OR 0.112; 95%CI: 0.017‐0.748); severe/life‐threatening aGVHD was associated with initial gastrointestinal aGVHD (OR 6.054; 95%CI:1.257‐29.159); and odds of mortality were decreased with male donor (OR 0.056; 95%CI:0.004‐0.804), nulliparous female donor (OR 0.076; 95%CI:0.009‐0.669), and focal vacuolar changes on skin biopsy (OR 0.113; 95%CI:0.017‐0.770).ConclusionsWe found novel indicators predictive of remission, severity, and mortality in children with aGVHD. Further studies of this condition in children are needed.

1Médico pasante del servicio social en investigación dermatología pediátrica. 2 Médico adscrito al departamento de dermatología.Instituto Nacional de Pediatría, México. INTRODUCCIÓNLas lesiones vasculares en lactantes y niños se clasifican principalmente en dos grupos: tumores y malformaciones vasculares. 1Los hemangiomas infantiles se encuentran dentro del grupo de tumores benignos junto con otros como el granuloma piógeno, hemangioendotelioma kaposiforme y el hemangioma en penacho. Sin embargo, los hemangiomas infantiles son los tumores vasculares más comunes. 2Los hemangiomas infantiles se caracterizan por tener una fase de crecimiento, de estabilidad y de involución; en contraste con las malformaciones vasculares que están conformadas por capilares, arterias, venas y vasos linfáticos anómalos y crecen de manera proporcional al crecimiento del niño, generalmente sin involucionar.2 Existen otros hemangiomas poco comunes con una rápida involución (RICH) o hemangiomas que no involucionan (NICH); distintos a los hemangiomas infantiles. 1 EPIDEMIOLOGÍALa verdadera incidencia de los hemangiomas infantiles se desconoce, pero se estima que cerca del 10% de los niños caucásicos los presentan.3 Algunos factores que predisponen a su aparición son: género femenino (de 2-3 veces más riesgo); 4 ser pre-término y con bajo peso al nacer; 5 productos de embarazos múltiples; edad materna avanzada; placenta previa o alguna otra anomalía placentaria. 5 CUADRO CLÍNICOLa mayoría de los hemangiomas infantiles no son clínicamente evidentes al nacimiento, sino en los primeros días a semanas de