Graft versus host disease from cancer treatment in palliative care
Acute and chronic graft versus host disease is common in patients with palliative care needs who have received haematopoietic cell or bone marrow transplantation. The skin is often involved, but mucosal, hair, nail and other organ damage can also occur.
Acute graft versus host disease involving the skin most commonly manifests as a pruritic or painful maculopapular rash. This initially appears over the ears, nape of the neck, shoulders, palms, and soles of the feet, but may become more generalised. More severe cases may present as bullous lesions with toxic epidermal necrolysis mimicking Stevens-Johnson syndrome.
Chronic graft versus host disease involving the skin can present in a variety of ways, including generalised erythema, plaques and waves of desquamation, mottled pigmentation, lichen planus-like lesions, sclerotic manifestations and poikiloderma.
Mild cases can be managed with topical treatments, while systemic corticosteroids may be required for more severe cases.
See the eviQ website for information on acute graft versus host disease and chronic graft versus host disease.