Graft-versus-Host Disease: How it Affects Skin, Nails and Hair

May 2, 2024
Presenter: Silvina Pugliese, MD, Stanford Cancer Institute
The presentation is 40 minutes long with 19 minutes of Q&A.
Summary: Graft-versus-host disease (GVHD) often affects the skin, nails, hair, mouth and/or genitals. This presentation will discuss potential treatments for various forms of acute and chronic skin GVHD, dry skin care, sun protection and how to monitor your skin for skin wounds and skin cancer.
Many thanks to Incyte and Sanofi whose support helped make this presentation possible. The presentation is part of the 2024 Virtual Celebrating a Second Chance at Life Survivorship Symposium.
To read the transcript, go to:
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Highlights:
60 to 80% of patients who have chronic graft-versus-host disease will have some degree of skin involvement.
Chronic GVHD can cause a skin rash, hair loss, itching, scaly bumps on the skin, scarring, tightness or rippled skin, mouth sores, dry lips, genital sores and/or decreased range of motion.
Chronic GVHD increases the risk of developing skin cancer. Good dry skin care and sun protection can help prevent flares of GVHD as well as skin cancer.
Key Points:
(14:15): The skin consists of several three layers. Symptoms of chronic skin GVHD differ depending on which layer of skin it is affecting.
(14:59): When chronic GVHD affects the top layer of skin - the epidermis - it looks like pink-purple bumps joined together in a large area, or like blood vessel on the skin. Topical steroids, topical calcineurin inhibitors, JAK inhibitors, and narrowband UVB light therapy are treatment options.
(19:12): When chronic GVHD affects the middle layer of the skin - the dermis - it looks like skin scarring and tightening. When it affects deepest layer of the skin - the subcutaneous tissue - it can look like cellulitis and cause grooves in the skin.
(22:46): Chronic GVHD can affect a person’s range of motion, making it difficult to fully extend hands, arms and feet, or raise arms over the head.
(23:49): Sometimes a skin biopsy is needed to diagnose skin GVHD to rule out other diseases that can look like GVHD.
(26:27): GVHD can affect the mouth and lips causing dryness and mouth sores. Topical steroids are the usual treatment.
(27:56): Chronic GVHD can affect genital skin causing pain in the vagina or on the penis, a burning sensation when urinating, painful sex and other changes. Topical steroids and calcineurin inhibitors are the usual treatment.
(29:15): Chronic GVHD can cause hair loss. Treatment for hair loss caused by GVHD may include topical or injected steroid or minoxidil.
(31:57): Graft-versus-host disease can cause lifting of the nails, lines running through the nails, or complete loss of nails. This is typically treated with topical steroids.
(37:17): Chronic GVHD increases the risk for skin cancers. Limiting sun exposure for long time periods of time, especially at peak UV-index times, using sunscreen with SPF-30 or higher, and wearing protective clothing can reduce the risk skin cancer.
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