Adult Cutaneous Chronic Graft-Versus-Host Disease: An In-Depth Review

Cutaneous chronic graft-versus-host disease (cGVHD) is a frequent and debilitating complication of allogeneic hematopoietic cell transplantation. Skin involvement affects most patients and may involve extensive body surface area in severe cases. Manifestations range from inflammatory lichenoid eruptions to fibrotic and sclerotic changes that cause pain, functional impairment, and reduced quality of life. This review summarizes current understandings of the immunopathogenesis, clinical presentation, diagnostic tools, and management of cutaneous cGVHD. Systemic corticosteroids remain first-line therapy, but responses are variable and prolonged use causes substantial toxicity. Recently, therapeutic agents such as ibrutinib, ruxolitinib, belumosudil, and axatilimab, which modulate distinct immune and fibrotic pathways, improved management of this condition. Nevertheless, relapse and treatment-refractory disease remain common. Emerging strategies target immune dysregulation and fibrosis. Advances in scoring systems, imaging, and patient-reported outcomes are improving disease assessment. Given its heterogeneity, individualized, mechanism-based treatments are needed to improve long-term outcomes.