Polańska Adriana, Łojko-Dankowska Anna, Czyż Anna, Adamski Zygmunt, Żaba Ryszard, Gil Lidia, Dańczak-Pazdrowska Aleksandra
Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.
Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
Postepy Dermatol Alergol. 2022 Dec;39(6):1083-1087. doi: 10.5114/ada.2022.116778. Epub 2022 Jun 7.
The skin is the typically and predominantly affected organ in patients after allogeneic hematopoietic stem cell transplantation (alloHSCT). The supportive therapy in patients after alloHSCT includes especially ultraviolet protection and the use of emollients.
Due to the lack of studies regarding epidermal barrier function in patients with alloHSCT, our aims were to monitor dermatologically patients 1 year after the procedure with special emphasis on epidermal barrier function and to evaluate the properties of epidermal barrier function in patients with confirmed chronic GvHD (cGvHD).
Our pilot study included 30 patients after alloHSCT and 20 healthy controls. In the group of patients after alloHSCT there were 10 individuals who were monitored dermatologically (including evaluation of skin, mucosae, nails and hair) within 1 year after the procedure (subgroup 1) and 20 patients with previously confirmed cGvHD (subgroup 2). We evaluated transepidermal water loss (TEWL), skin hydration and skin color. The clinical assessment and all noninvasive evaluations in patients included in subgroup 1 were performed before (at baseline) and 3, 6, 9 and 12 months after the procedure, while in subgroup 2 they were performed once.
In subgroup 1 we did not observe significant differences between baseline results and periods of assessments in TEWL values or corneometry, erythema and melanin measurements. In subgroup 2 the highest TEWL values and the lowest corneometry results were observed in patients with sclerodermoid chronic cutaneous GvHD in comparison to patients with lichenoid chronic cutaneous GvHD and patients with cGvHD but without skin lesions. TEWL values and melanin level were significantly higher in patients with cGvHD than in controls.
Our pioneer observations proved the disturbed epidermal barrier function among patients after alloHSCT. Therefore it seems that proper skin care, including photoprotection, should be recognized as a crucial component in long-term management of these patients.
皮肤是异基因造血干细胞移植（alloHSCT）患者中典型且主要受累的器官。alloHSCT患者的支持性治疗尤其包括紫外线防护和使用润肤剂。
由于缺乏关于alloHSCT患者表皮屏障功能的研究，我们的目的是在术后1年对皮肤科患者进行监测，特别关注表皮屏障功能，并评估确诊为慢性移植物抗宿主病（cGvHD）患者的表皮屏障功能特性。
我们的初步研究纳入了30例alloHSCT术后患者和20例健康对照。在alloHSCT术后患者组中，有10例在术后1年内接受皮肤科监测（包括皮肤、黏膜、指甲和毛发评估）（亚组1），20例先前确诊为cGvHD的患者（亚组2）。我们评估了经表皮水分流失（TEWL）、皮肤水合作用和皮肤颜色。亚组1患者的临床评估和所有非侵入性评估在术前（基线）以及术后3、6、9和12个月进行，而亚组2患者仅进行一次评估。
在亚组1中，我们未观察到TEWL值或角质层测量、红斑和黑色素测量的基线结果与评估期之间存在显著差异。在亚组2中，与苔藓样慢性皮肤型GvHD患者和有cGvHD但无皮肤病变的患者相比，硬皮病样慢性皮肤型GvHD患者的TEWL值最高，角质层测量结果最低。cGvHD患者的TEWL值和黑色素水平显著高于对照组。
我们的初步观察证明alloHSCT术后患者存在表皮屏障功能紊乱。因此，适当的皮肤护理，包括光防护，似乎应被视为这些患者长期管理的关键组成部分。
