High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease

摘要

Aim To determine the frequency and the characteristicsof cutaneous manifestations, especially vitiligo and alopeciaareata, in patients with chronic graft-vs-host disease(cGVHD).Methods 50 patients with cGVHD were prospectively enrolledin the observational study protocol and evaluated byan experienced dermatologist. The evaluation was focusedon the clinical spectrum of skin and adnexal involvement,and the cutaneous GVHD score was determined accordingto National Institutes of Health (NIH) Consensus criteria.The presence of vitiligo, alopecia, xerosis, nail changes, anddyspigmentation was also assessed.Results Out of 50 cGVHD patients, 28 (56%) had skin involvement,and 27 of them (96%) had hypo and/or hyperpigmentations.11 patients (39%) had a mild cutaneous NIHcGVHD score, 22% moderate, and 39% severe. 15 (30%) patientshad nail changes and 10 (20%) had vitiligo or alopeciaareata. Univariate analysis showed that patients with vitiligo/alopecia areata received more lines of prior systemicimmunosuppressive therapy (P = 0.043), had lower Karnofskyperformance status (P = 0.028), and had a higher B-cellnumber (P = 0.005), platelet count (P = 0.022), and total protein(P = 0.024). Vitiligo and alopecia areata were associatedwith higher NIH skin score (P = 0.001), higher intensity ofimmunosuppressive treatment (P = 0.020), and total bodyirradiation conditioning (P = 0.040). Multivariate regressionmodel showed that patients with higher NIH skin scoringwere 3.67 times more likely to have alopecia and/or vitiligo(odds ratio 3.67; 95% confidence interval 1.26-10.73), controlledfor all other factors in the model (age at study entry,number of B-cells, platelet count, and global NIH score).Conclusion These data indicate that vitiligo and alopeciaareata occur more frequently in cGVHD than previously reported.