Chronic cutaneous sclerodermoid graft-versus-host disease: evaluation by 20-MHz sonography.
BACKGROUND
Chronic graft-versus-host disease (GVHD) is an immunological disorder frequently occurring as a late consequence of allogeneic bone marrow transplantation. Two variants, cutaneous lichenoid and sclerodermoid, have been described, based on clinical and histopathological examinations. It is, however, difficult to determine non-invasively the degree of cutaneous GVHD in vivo. Ultrasonographic methods have recently provided us with the means for objective and non-invasive monitoring of the dynamics of many chronic skin diseases.


OBJECTIVE
In five patients with chronic cutaneous sclerodermoid GVHD skin thickness was measured with a 20-MHz B-mode ultrasound scanner (DUB 20S, taberna pro medicum, Lüneburg, Germany) in a clinically well-defined target skin lesion. Additionally cutaneous GVHD was assessed histologically before and after treatment.


RESULTS
In all patients before treatment the corium of sclerotic skin was thicker than the corresponding areas of healthy skin. The skin thickness was increased from 45% to 83%. In the subcutaneous tissue proper echo-rich reflexes were prominent, representing the correlate of subcutaneous fibrotic trabeculae. In all patients ultrasonographic evidence of regression was shown (decrease of skin thickness by 18-83%). Moreover, it was demonstrated that quantitative assessment of skin thickness is feasible.


CONCLUSIONS
In this paper we describe the detailed sonographic features of cutaneous sclerodermoid GVHD for the first time. As the method is simple and non-invasive, repeated examinations are possible. This provides the basis for monitoring treatment effects and efficient follow-up in these chronically progressive clinical conditions after bone marrow transplantation.
Gottlöber
P
P
Department of Dermatology, University of Ulm, Oberer Eselsberg, Ulm, Germany. Petra.Gottloeber@medizin.uni-ulm.de
Leiter
U
U
Friedrich
W
W
Bunjes
D
D
Schulz
A
A
Kerscher
M
M
Peter
R U
RU
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012594:Scleroderma, Localized / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography
D007166:Immunosuppressive Agents