Skin and wound care for individuals with graft versus host disease: a scoping review protocol

Abstract

IntroductionGraft versus host disease (GVHD) is a major cause of morbidity and mortality following allogenic haematopoietic stem cell transplantation. It is an immunological reaction, involving many organs, leading to a wide range of clinical manifestations. Cutaneous manifestations are the most common sign of GVHD, as well as pain, vulnerability to infection and impaired quality of life.Despite the burdens that cutaneous GVHD presents for patients, their carers and the healthcare system, limited evidence is available to guide day to day supportive skin care and wound management. Our objective is to conduct a scoping review to map the evidence for skin and wound management and identify evidence-practice gaps for individuals with acute or chronic cutaneous GVHD.Methods and analysisOur review will follow the scoping review methodological framework developed by Arksey and O’Malley and further refined by the Joanna Briggs Institute Scoping Review Methods Manual. Databases to be searched include; PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science and MEDLINE from 1970 to February 2020. Database searches will be supplemented with searches from relevant reference lists and grey literature. Descriptive statistical analyses will be performed.Ethics and disseminationThis scoping review does not require ethical approval. Findings will be disseminated through a peer-reviewed publication and conference presentation.

The Management of Chronic Graft-Versus-Host Disease Skin Ulcers after Hematopoietic Stem Cell Transplantation: A Case Report

“…2,9 However, only a few cases have reported details of daily supportive skin care (including cleansing, moisturizing, and maintaining skin integrity); wound management procedures including dressing and product selection; and pain, pruritus, and other symptom management. 4 This report describes a patient with cGVHD with ulcers on the right lower leg that began 140 weeks after HSCT. The patient provided informed consent to publish the case details and associated images.…”

“…Typical clinical manifestations (skin desquamation, blisters, crusty skin, macular papule-like rash, pruritus, and sclerosis) may only occur as the disease progresses. 3,4 Few reports on skin ulcers related to cGVHD exist. Skin rejection in cGVHD usually begins around 4 months posttransplantation.…”

“…The onset of cGVHD is insidious, with nonspecific skin manifestations such as dry skin and ichthyosis. Typical clinical manifestations (skin desquamation, blisters, crusty skin, macular papule-like rash, pruritus, and sclerosis) may only occur as the disease progresses 3,4 . Few reports on skin ulcers related to cGVHD exist.…”

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

“…Other manifestations typically observed in c-GvHD are lichenoid eruptions, sclerotic changes, eosinophilic fasciitis features, all of which are usually associated with itching, dysesthesia, pain and vulnerability to infection. 17 Besides the clinical manifestations, the major implication of c-GvHD consists on its hard impact on quality of life (QoL) and well-being in affected patients, whose knowledge may improve medical decision-making and symptom management over time. 18 Nowadays, treatment of patients with c-GvHD is still an enormous clinical challenge; while the need for skin-directed therapies such as physical therapies and topical medications are generally accepted, the gold standard treatment strategy still remains a grey area.…”

“…Patients suffering from cutaneous GvHD may experience a variety of skin lesions, including erythematous maculopapular morbilliform rash (the typical manifestation of a‐GvHD) ranging from localized to a generalized, erythrodermic form. Other manifestations typically observed in c‐GvHD are lichenoid eruptions, sclerotic changes, eosinophilic fasciitis features, all of which are usually associated with itching, dysesthesia, pain and vulnerability to infection 17 …”