Pediatric Cutaneous Graft Versus Host Disease: A Review
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Updated: Feb 27, 2026
Murine Full-thickness Skin Transplantation
Published on: January 2, 2017
Connie R Shi1, Jennifer T Huang2, Vinod E Nambudiri1
1Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, MA. United States.
Insights
Pediatric cutaneous graft-versus-host disease (GVHD) presents varied skin manifestations post-transplant. Early diagnosis and treatment, including corticosteroids and novel therapies, are crucial for managing this complication.
Area of Science:
- Hematology
- Immunology
- Dermatology
Background:
- Graft-versus-host disease (GVHD) is a major complication after pediatric hematopoietic stem cell transplantation.
- Cutaneous GVHD, the most frequent clinical form, requires thorough understanding of its pathophysiology and epidemiology.
- This review covers key aspects of pediatric cutaneous GVHD, from basic science to clinical management.
Purpose of the Study:
- To review essential concepts of pediatric cutaneous GVHD.
- To elucidate the pathophysiology, clinical epidemiology, diagnosis, and treatment of pediatric cutaneous GVHD.
- To highlight the heterogeneity in clinical presentations and long-term morbidity.
Main Methods:
- Review of existing literature on pediatric cutaneous GVHD.
- Analysis of clinical presentations, including acute and chronic forms.
- Summary of current and emerging treatment strategies.
Main Results:
- Acute cutaneous GVHD typically appears as a rash weeks post-transplant.
- Chronic cutaneous GVHD can manifest as poikiloderma, lichenoid, or sclerodermatous changes.
- Sclerodermatous GVHD leads to significant long-term issues like joint contractures and mobility limitations.
Conclusions:
- Accurate diagnosis of cutaneous GVHD is vital.
- Effective treatment is essential to prevent long-term morbidity.
- Management strategies encompass pharmacologic and non-pharmacologic approaches, with ongoing research into new therapies.
Background:
Graft versus host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation in the pediatric population. The most common clinical manifestation of GVHD is in the skin. This article will present a review of key concepts related to pediatric cutaneous GVHD, including pathophysiology, clinical epidemiology, diagnosis, and treatment options.
Objective:
GVHD is an immune-mediated process characterized by an inflammatory immune response in acute GVHD and mixed inflammatory and fibrotic states in chronic GVHD. The clinical presentations of cutaneous GVHD are heterogeneous.
Method:
Acute cutaneous GVHD classically presents as an erythematous morbilliform eruption appearing within a few weeks after transplantation. Chronic cutaneous GVHD may manifest as poikiloderma, lichenoid lesions, or sclerodermatous changes. The sclerodermatous form of cutaneous GVHD is associated with substantial long-term morbidity, including joint contractures, myalgias, and mobility restriction.
Results:
First-line pharmacologic treatment options typically include corticosteroids and in some cases, calcineurin inhibitors. Biologics and immunotherapies are an active area of investigation for GVHD that is refractory to corticosteroid treatment. Non-pharmacologic treatment options that have shown benefit for cutaneous GVHD include extracorporeal photopheresis and phototherapy.
Conclusion:
Accurate diagnosis and treatment of cutaneous GVHD is essential to preventing and alleviating the long-term sequelae and morbidity associated with this condition.
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