Table 7. Chronic Graft-versus-Host Disease (GVHD) Symptoms in the Skin, Nails, Scalp, and Body Haira
| Organ or Site | Diagnosticb | Distinctivec | Other Featuresd | Common (Seen with Both Acute and Chronic GVHD) |
| Skin | Poikiloderma | Depigmentation | Sweat impairment | Pruritus |
| Lichen planus-like features | Ichthyosis | Erythema | ||
| Sclerotic features | Keratosis pilaris | Maculopapular rash | ||
| Morphea-like features | Hypopigmentation | |||
| Lichen sclerosus-like features | Hyperpigmentation | |||
| Nails | Dystrophy | |||
| Longitudinal ridging, splitting, or brittle features | ||||
| Onycholysis | ||||
| Pterygium unguis | ||||
| Nail loss (usually symmetric; affects most nails)e | ||||
| Scalp and body hair | New onset of scarring or nonscarring scalp alopecia (after recovery from chemoradiotherapy) | Thinning scalp hair, typically patchy, coarse, or dull (not explained by endocrine or other causes) | ||
| Scaling, papulosquamous lesions | Premature gray hair | |||
| aReprinted from Biology of Blood and Marrow Transplantation, 11 (12), Alexandra H. Filipovich, Daniel Weisdorf, Steven Pavletic, Gerard Socie, John R. Wingard, Stephanie J. Lee, Paul Martin, Jason Chien, Donna Przepiorka, Daniel Couriel, Edward W. Cowen, Patricia Dinndorf, Ann Farrell, Robert Hartzman, Jean Henslee-Downey, David Jacobsohn, George McDonald, Barbara Mittleman, J. Douglas Rizzo, Michael Robinson, Mark Schubert, Kirk Schultz, Howard Shulman, Maria Turner, Georgia Vogelsang, Mary E.D. Flowers, National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report, Pages 945-956, Copyright (2005), with permission from Elsevier.[36] | ||||
| bSufficient to establish the diagnosis of chronic GVHD. | ||||
| cSeen in chronic GVHD, but insufficient alone to establish a diagnosis of chronic GVHD. | ||||
| dCan be acknowledged as part of the chronic GVHD symptomatology if the diagnosis is confirmed. | ||||
| eIn all cases, infection, drug effects, malignancy, or other causes must be excluded. | ||||
| fDiagnosis of chronic GVHD requires biopsy or radiology confirmation (or Schirmer test for eyes). |
References
- Filipovich AH, Weisdorf D, Pavletic S, et al.: National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 11 (12): 945-56, 2005. [PUBMED Abstract]
