Eczematoid Graft-vs-Host Disease

Creamer, Daniel; Martyn-Simmons, Claire; Osborne, G; Kenyon, Michelle; Salisbury, Jonathan R.; Devereux, Stephen; Pagliuca, Antonio; Ho, Aloysius; Mufti, Ghulam J.; Vivier, Anthony du

doi:10.1001/archderm.143.9.1157

Cited by 55 publications

(7 citation statements)

References 13 publications

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“…Because GvHD can present with a wide variety of histopathologic patterns, including psoriasiform, interface, and eczematous, clinical‐histopathologic correlation is paramount. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

et al. 2022

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Background: Categorization of biopsy specimens into inflammatory reaction patterns is central to dermatopathologic assessment. Mixed inflammatory patterns are poorly characterized and may represent clinicopathologic challenges. The purpose of this study was to identify clinical and histopathologic findings associated with the mixed spongiotic-interface dermatitis (SID) histopathologic pattern.Methods: Fifty-one institutional biopsy specimens of SID were identified over a 2-year period by retrospective natural language search. Histopathologic and clinical features were identified. Results:The most common histopathologic features associated with SID were mild spongiosis (51%), focal vacuolar interface change (72%), lymphocytic exocytosis (92%), and superficial-dermal lymphocytic infiltrate (94%) with variable eosinophils (61%). Clinically, 80% of subjects presented with a symmetric morbilliform eruption.Polypharmacy (94%), immunosuppression (47%), and history of malignancy (47%) were common. The most common diagnoses were drug reaction (37%), possible drug reaction (12%), and viral exanthem (12%). Drug reaction with eosinophilia and systemic symptoms represented 25% of all confirmed cutaneous adverse drug reactions (CADR). Average time from drug initiation to symptom initiation was 20 days (SD: 22.3, range: 0-90); median disease duration was 25.5 days. Spongiotic vesicles and Langerhans cells were less common in patients with a strong clinicopathologic diagnosis of drug reaction compared to non-drug eruptions (p = 0.04). Conclusions:The mixed SID pattern is commonly encountered in CADR but may represent a more subacute course, implying consideration for inciting medication(s) started before the typical 7-to 14-day window.

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“…Because GvHD can present with a wide variety of histopathologic patterns, including psoriasiform, interface, and eczematous, clinical‐histopathologic correlation is paramount. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

et al. 2022

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“…An eczematous change was also observed on the area of confluent erythema. Ichthyosiform GVHD has been reported previously, while eczematoid GVHD is recognised as a rare variant of chronic cutaneous GVHD . Interestingly, in our patient histological characteristics of both PRP and aGVHD coexisted in the same specimen.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical patterns of dermatoses have been reported as manifestations of cutaneous acute or chronic GVHD. These include psoriasiform, ichthyosiform, eczematoid and follicular eruptions. We present a case of cutaneous aGVHD with clinical and histological features resembling type II (atypical adult) pityriasis rubra pilaris (PRP).…”

Section: Introductionmentioning

confidence: 99%

Acute cutaneous graft‐versus‐host disease resembling type II (atypical adult) pityriasis rubra pilaris

et al. 2013

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We present a case of cutaneous acute graft-versus-host disease (aGVHD) with confluent erythematous perifollicular hyperkeratosis and ichthyosiform scale in the clinical pattern of type II (atypical adult) pityriasis rubra pilaris (PRP), which developed 26 days after allogeneic peripheral blood stem cell transplant. Skin histology confirmed features of both aGVHD and PRP. The skin lesions were refractory to oral prednisolone and cyclosporine and only partially responsive to a combination of i.v. methylprednisolone, oral tacrolimus, oral mycophenolate mofetil, and infusions of anti-thymocyte globulin and the tumour necrosis factor-α inhibitor, etanercept.

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“…The mainstay of treatment includes oral corticosteroids with or without other systemic immunosuppressives. Emollients, topical corticosteroids and calcineurin inhibitors, oral antihistamines, narrowband ultraviolet B or psoralen with long‐wave ultraviolet A are also utilized 3,5 . Although patients often respond to treatment, flares are common when tapering systemic immunosuppressives.…”

Section: Introductionmentioning

confidence: 99%

“…Emollients, topical corticosteroids and calcineurin inhibitors, oral antihistamines, narrowband ultraviolet B or psoralen with long-wave ultraviolet A are also utilized. 3,5 Although patients often respond to treatment, flares are common when tapering systemic immunosuppressives. With the risks of chronic immunosuppression, alternative safe and effective therapies are needed.…”

Section: Introductionmentioning

confidence: 99%

Atopic dermatitis‐like graft‐versus‐host disease treated with dupilumab

Larijani

Zarowin

Wohlschlaeger

et al. 2022

Pediatric Dermatology

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The mainstay of treatment for atopic dermatitis (AD)-like graft-versus-host disease (GVHD) in both pediatric and adult patients includes oral corticosteroids with or without other systemic immunosuppressive therapies. To our knowledge, we report the first case series of dupilumab in the treatment of AD-like GVHD in a pediatric cohort of four patients, where we observed clinical improvement of GVHD as well as a reduction in itch in 3/4 (75%) patients. Our findings suggest that dupilumab is not only effective in treating AD-like GVHD, but also reduces systemic immunosuppression in the pediatric transplant population. The ability to reduce the length and amount of immunosuppression as well as improve quality of life suggest that dupilumab may serve as a safe and effective therapeutic option in our transplant population with GVHD.

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Eczematoid Graft-vs-Host Disease

Cited by 55 publications

References 13 publications

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

Acute cutaneous graft‐versus‐host disease resembling type II (atypical adult) pityriasis rubra pilaris

Atopic dermatitis‐like graft‐versus‐host disease treated with dupilumab

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