Ghoreschi Kamran, Thomas Peter, Penovici Marius, Ullmann Johanna, Sander Christian A, Ledderose Georg, Plewig Gerd, Kolb Hans-Jochem, Röcken Martin
Department of Dermatology, Eberhard Karls University, Liebermeisterstr. 25, 72076 Tübingen, Germany.
Eur J Dermatol. 2008 Nov-Dec;18(6):667-70. doi: 10.1684/ejd.2008.0517. Epub 2008 Oct 27.
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 on 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 photochemotherapy 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 photochemotherapy was continued. Thus, PUVA-bath photochemotherapy alone or in combination with isotretinoin may resolve or improve GVHD associated sclerosis in selected patients.
慢性移植物抗宿主病（GVHD）几乎总是与皮肤疾病相关，表现为苔藓样GVHD、硬皮病样GVHD（sGVHD）或嗜酸性筋膜炎样疾病。后两种情况常导致严重且深度的硬化。免疫抑制疗法对硬皮病样或嗜酸性筋膜炎样类型的GVHD帮助不大。基于显示补骨脂素浴光化学疗法对治疗严重局限性皮肤硬化有效的数据，我们研究了补骨脂素浴光化学疗法和异维A酸在sGVHD中的疗效。在一项回顾性研究中，我们分析了连续14例接受补骨脂素浴光化学疗法的sGVHD患者，其中5例联合口服异维A酸。7例患者病情改善，4例完全缓解。令人惊讶的是，治疗在早期出现了硬化斑块内溃疡的并发症。当继续进行补骨脂素浴光化学疗法时，大多数患者的这些溃疡得以愈合。因此，单独使用补骨脂素浴光化学疗法或与异维A酸联合使用，可能会使部分患者的GVHD相关硬化得到缓解或改善。
