ABSTRACT
Graft versus host disease (GVHD) is a multisystem disorder occurring after hematopoietic cell transplant and sometimes in donor lymphocyte infusions and organ transplantation. It arises because of allograft rejection by the immunocompetent alloreactive donor T lymphocytes, which recognize the minor or major histocompatibility antigens on the target tissue of the host, leading to multiorgan involvement. Cutaneous manifestations are some of the earliest manifestations of acute GVHD, thus serving as red flag signs. Skin involvement in chronic GVHD worsens the general debility along with multiorgan involvement. A multidisciplinary approach to management involving the hematologist, dermatologist, ophthalmologist, gastroenterologist, and rheumatologist is recommended. The primary role of the dermatologist is to aid in the diagnosis, especially so in acute GVHD as it relies on clinical evaluation in the absence of pathognomonic histopathological features. Management of acute cutaneous GVHD includes topical agents for symptom relief and systemic agents that are usually instituted for multiorgan involvement. Chronic cutaneous GVHD needs not only symptomatic treatment but an active follow-up to watch the areas of breakdown for chronic ulceration and malignancies.
