Isomorphic Sclerotic-Type Cutaneous Chronic Graft-Versus-Host Disease: Report and Review of Chronic Graft-Versus-Host Disease in a Cutaneous Immunocompromised District

Abstract

BackgroundPatients who have received a hematopoietic cell transplantation can develop graft-versus-host disease (GVHD). The liver, the gastrointestinal tract, and/or the skin can be affected by GVHD. Chronic sclerotic-type cutaneous GVHD can occur at sites of repetitive skin friction.PurposeTo describe isomorphic sclerotic-type GVHD and review chronic GVHD appearing in a cutaneous immunocompromised district.MethodsThe clinical features of a 74-year-old man with mantle cell lymphoma who developed chronic sclerotic-type cutaneous GVHD localized to the waistband area—which had been exposed to repetitive skin injury—after a second hematopoietic cell transplantation are reported. Using the PubMed database, an extensive literature search was performed on chronic GVHD.Case report and reviewThe cutaneous immunocompromised district is an area of skin whose local effective immunity has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor at the site. A cutaneous isomorphic response refers to a disease-associated skin lesion occurring at the site of physical injury that is morphologically similar to the existing condition. Cutaneous chronic GVHD can occur at sites of repetitive skin trauma as an isomorphic response. The patient developed sclerotic-type GVHD in a cutaneous area that had previously experienced repeated irritation, friction, and pressure. Isomorphic sclerotic-type GVHD—in either the waistband area or brassiere area or both—has also been observed in other patients. In addition, cutaneous chronic GVHD has been described not only at the location of a previous, unrelated, and healed skin disease as an isotopic response, but also at the cutaneous site of earlier exposure to radiotherapy or ultraviolet radiation as an isoradiotopic response.ConclusionSclerotic and nonsclerotic skin lesions of chronic GVHD can occur not only as an isomorphic response, but also as either an isotopic response or an isoradiotopic response in a cutaneous immunocompromised district.

Chronic cutaneous lichenoid graft-versus-host disease at the area of herpes zoster infection and at a vaccination site

“…Isolated cases of cutaneous GVHD following a dermatomal pattern without a confirmed herpes zoster infection in the affected area have been reported, as well as following Blaschko's lines . Chronic cutaneous sclerodermiform GVHD has also been published as the result of Koebner isomorphic phenomenon in pressure and friction areas, at a central catheter site and of repeated needle sticks and after sun or narrowband ultraviolet B‐exposed area . Isoradiotopic response has also been described with the development of cutaneous GVHD lesions after ionizing radiotherapy …”

“…There are few reports in the medical literature regarding its appearance at the site of previous VZV infection. In seven of the nine published cases this was caused by a Wolf's isotopic response . Renbök phenomenon was a term coined by Happle et al .…”

“…Graft‐versus‐host disease (GVHD) remains a frequent complication of allogeneic bone marrow transplant and haematopoietic cell transplantation . It can affect the skin and mucosae, the liver and the gastrointestinal tract …”

“…Graft-versus-host disease (GVHD) remains a frequent complication of allogeneic bone marrow transplant 1 and haematopoietic cell transplantation. 2 It can affect the skin and mucosae, the liver and the gastrointestinal tract. 2 Wolf's isotopic response is defined as the development of a new cutaneous condition at the location of a previous, unrelated, and already healed skin disease.…”

“…2 It can affect the skin and mucosae, the liver and the gastrointestinal tract. 2 Wolf's isotopic response is defined as the development of a new cutaneous condition at the location of a previous, unrelated, and already healed skin disease. 3 The Koebner isomorphic response refers to the appearance of a skin lesion at a site of injury that is morphologically similar to an existing skin disease.…”