Chronic Graft versus Host Disease of the Skin

Definition

Attack by engrafted hematopoietic cells and their progeny on host cutaneous tissues resulting in lichenoid or sclerodermatous changes

Lichenoid type
- Occurs any time post-transplant
- Looks like lichen planus but with scant infiltrate
  - Epidermal atrophy or irregular acanthosis
  - Wedge shaped hypergranulosis
  - Squamatization of dermal-epidermal junction
  - Scant bandlike lymphocytic infiltrate
Sclerodermatous type
- Occurs 6-12 month post-transplant
- Looks like morphea
  - Square biopsy
  - Homogenized and thickened collagen bundles
  - Loss of hair follicles
  - Replacement of peri-eccrine fat
Chronic GVHD is not graded
- Extent of disease (localized vs. generalized) is more important than histological severity

Sabine Kohler MD
Neeraja Kambham MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342