Itin P H, Lautenschlager S, Orth B, Rufli T, Gratwohl A
Departement für Dermatologie, Universitätsklinik Basel.
Schweiz Med Wochenschr. 1996 Mar 2;126(9):339-47.
We review the cutaneous manifestations of acute and chronic graft versus host disease (GvHD). Acute GvHD is characterized by initial itching, pain on pressure and erythema which begins on posterior auricular skin, palms and soles. The disease evolves into a typical but nonspecific maculopapular rash. Confluent rashes and follicular erythema may occur. Erosive oral lesions usually develop. The most severe variant of GvHD is toxic epidermal necrolysis, which often has a fatal outcome. The onset of chronic GvHD usually occurs more than 100 days after bone marrow transplantation and may be preceded by the acute form. The spectrum of skin changes includes lichenoid pruritic lesions with violaceous color and scleroderma-like skin involvement. Investigation of unknown rashes in these patients includes skin biopsy, which clearly differentiates leukocytoclastic vasculitis and erythema exsudativum multiforme with lymphocytic vasculitis from cutaneous manifestations of GvHD. Special stains may reveal bacteria and fungus in septicemic patients. The therapeutic options are discussed.
我们回顾了急性和慢性移植物抗宿主病（GvHD）的皮肤表现。急性移植物抗宿主病的特征是起初出现瘙痒、压痛性疼痛以及红斑，最初出现在耳后皮肤、手掌和脚底。疾病会发展为典型但非特异性的斑丘疹。可能会出现融合性皮疹和毛囊性红斑。通常会出现糜烂性口腔病变。移植物抗宿主病最严重的变体是中毒性表皮坏死松解症，其往往会导致致命后果。慢性移植物抗宿主病通常在骨髓移植100多天后发生，可能先有急性形式。皮肤变化的范围包括呈紫罗兰色的苔藓样瘙痒性病变和硬皮病样皮肤受累。对这些患者不明皮疹的检查包括皮肤活检，这能清楚地将白细胞破碎性血管炎、多形性渗出性红斑伴淋巴细胞性血管炎与移植物抗宿主病的皮肤表现区分开来。特殊染色可能会在败血症患者中发现细菌和真菌。文中讨论了治疗选择。
