Journal
EUROPEAN JOURNAL OF DERMATOLOGY
Volume 18, Issue 6, Pages 667-670Publisher
JOHN LIBBEY EUROTEXT LTD
DOI: 10.1684/ejd.2008.0517
Keywords
Graft-versus-host disease; phototherapy; psoralen; retinoid; scleroderma; ultraviolet A
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Chronic graft-versus-host disease (GVHD) is almost always associated with skin diseases appearing either as lichenoid GVHD, sclerodermatous GVHD (sGVHD) or as eosinophilic fasciitis-like disease. The two latter frequently result in severe and deep sclerosis. Immunosuppressive therapy is of little help in sclerodermatous or eosinophilic fasciitis-like types of GVHD. Based oil data showing that PUVA-bath photochemotherapy is effective in the treatment of severe localized sclerosis of the skin, we investigated the efficacy of PUVA-bath photochernotherapy and isotretinoin in sGVHD. In a retrospective study we analyzed fourteen consecutive patients with sGVHD who received PUVA-bath photochemotherapy, five in combination with oral isotretinoin. Seven patients improved and four showed complete remission. Surprisingly, the therapy was complicated by the development of ulcers within the sclerotic plaques during the early periods of treatment. These ulcers cleared in most patients when PUVA-bath photochernotherapy Was Continued. Thus, PUVA-bath photochernotherapy alone or in combination with isotretinoin may resolve or improve GVHD associated sclerosis in selected patients.
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