In this review of the clinical and histopathologic manifestations of the graft-vs-host reaction, the characteristic changes in the skin are given particular emphasis, since they are among the earliest and most obvious signs of this syndrome. The acute and chronic forms of graft-vs-host disease are distinguished, with notation of their different dermatologic presentations. The distinctive histopathologic and immunopathologic findings of the graft-vs-host reaction in the skin are presented. Finally, the possible pathogenetic mechanisms which produce the clinical picture of graft-vs-host disease are discussed. Both T cells and B cells apparently are involved, as are macrophages, but what is primary and what is secondary in the reaction remains to be delineated, as do the respective contributions of donor and host cells.
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