Phototherapy and topical treatments for cutaneous graft vs. host disease in haematopoietic stem cell transplantation patients: a scoping review

Abstract

Skin is usually the first and most affected organ involved in graft-versus-host disease (GvHD), and treatment is still a clinical challenge. Although the need for skin-directed treatments such as physical treatments and topical medications are generally agreed on, what the gold standard treatment strategy should be remains open to debate. The aim of this scoping review was to synthesize the current knowledge on the topical and physical treatments of cutaneous GvHD in haematopoietic stem cell transplantation patients and to highlight the best evidence available so as to reduce the gap between 'what is known' and 'what is done' in the clinical practice. Twenty-eight studies were included in this qualitative synthesis. Photo-biomodulation with psoralen was not included in this review. Phototherapy (ultraviolet A or B or narrowband B) was the physical treatment most described in the literature in both acute GvHD and chronic GvHD. Topical calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream as well as corticosteroid creams such as clobetasol and triamcinolone are mainly used in case of chronic GvHD. In all of the studies included in the review, topical treatments were always associated with systemic therapy. None of the topical interventions identified in our review provided strong evidence supporting its use, and the topical approaches seemed to have an adjuvant role in the treatment of cutaneous GvHD.

Bath psoralen plus ultraviolet‐A photochemotherapy for chronic graft‐versus‐host disease: a retrospective cohort study

“…Various phototherapeutic modalities, including PUVA, UVA1, NB-UVB, ECP, and bath PUVA, have been used to treat chronic cutaneous GVHD. 34 However, reports on these treatments are limited to small case series and reports. For example, Volc-Platzer et al treated four patients with cGVHD with systemic PUVA: two patients' skin lesions improved considerably, reducing the immunosuppressive therapy requirement; treatment discontinuation due to gastrointestinal side effects (nausea and vomiting) occurred in one patient; and no improvement was seen in one patient.…”

“…Various phototherapeutic modalities, including PUVA, UVA1, NB‐UVB, ECP, and bath PUVA, have been used to treat chronic cutaneous GVHD 34 . However, reports on these treatments are limited to small case series and reports.…”

Novel Approaches to the Treatment of Chronic Graft-Versus-Host Disease

“…Depending on the affected organs, cGVHD treatment may include local measures such as topical therapy with ointments and local UV therapy. 16,17 For cGVHD of the eyes, calcineurin inhibitor eyes drops can be used, 18 and for cGVHD of the lungs, montelukast and azithromycin in combination with inhaled GC can be used. 19 Supportive measures such as physiotherapy in patients with fasciitis 16 and tear drop replacement for cGvHD involving the eyes 18 may help to reduce symptom burden.…”