title: Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions.
abstract: BACKGROUND
  The early diagnosis of acute cutaneous graft-versus-host disease (GVHD) is challenging as there are no specific features. Drug hypersensitivity reaction (DHR) is the most frequently encountered condition to differentiate from GVHD.
  
  
  OBJECTIVE
  We sought to investigate the clinical characteristics of acute cutaneous GVHD in comparison with DHR.
  
  
  METHODS
  A retrospective chart review was conducted for allogeneic hemopoietic-cell transplantation recipients with maculopapular rashes who had undergone hemopoietic-cell transplantation less than 100 days earlier. We analyzed the clinical characteristics of 22 patients with acute cutaneous GVHD in comparison with 17 patients with DHR.
  
  
  RESULTS
  Facial involvement was more frequent in the GVHD group (59%) than in the DHR group (24%). The difference was more significant when both the face and palms/soles were involved (36% in the GVHD group, no patients in the DHR group). Diarrhea was significantly more common in the GVHD group (73%) than in the DHR group (12%). The presence of both diarrhea and hyperbilirubinemia occurred only in the GVHD group (41%). In the GVHD group, the patients developed diarrhea and hyperbilirubinemia gradually with most patients exhibiting diarrhea and hyperbilirubinemia after 2 days.
  
  
  CONCLUSIONS
  A retrospective design, small number of patients, and single-center design are limitations.
  
  
  CONCLUSIONS
  Facial involvement, and moreover involvement of the face and palms/soles, suggests the diagnosis of GVHD versus DHR. The presence of diarrhea, and diarrhea accompanied by hyperbilirubinemia is thought to favor the diagnosis of GVHD. Rashes with more than 2 to 3 days of duration and not accompanied by diarrhea and hyperbilirubinemia are less likely to be GVHD.
authors.affiliation: Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul, Korea; Laboratory of Cutaneous Aging Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Byun
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Gangnam Healthcare Center, Seoul, Korea.
authors.forename: Jong In
authors.initials: JI
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Byoung Kook
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul, Korea; Laboratory of Cutaneous Aging Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. Electronic address: khcho@snu.ac.kr.
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005148:Facial Dermatoses / Q000175:diagnosis; D005260:Female; D005533:Foot Dermatoses / Q000175:diagnosis; D006086:Graft vs Host Disease / Q000175:diagnosis*; D006229:Hand Dermatoses / Q000175:diagnosis; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis*