title: Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury: potential insight into the mechanism of isomorphic and isotopic responses.
abstract: BACKGROUND
  The mechanisms responsible for the variable manifestations of chronic cutaneous graft-vs-host disease (cGVHD) are poorly understood. Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury (isomorphic and isotopic responses), a recognized phenomenon in morphea, suggests a potential common pathway between cGVHD and other sclerotic skin conditions.
  
  
  METHODS
  Four cases of sclerotic-type cGVHD developed at the site of disparate skin injuries (ionizing radiotherapy, repeated needle sticks, central catheter site, and varicella-zoster virus infection). We review the spectrum of previously reported cases of sclerotic and nonsclerotic cGVHD relating to external forces on the skin.
  
  
  CONCLUSIONS
  Localization of sclerotic-type cGVHD may occur after many types of skin injury, including UV and ionizing radiotherapy, needle sticks, viral infection, and pressure or friction. Recognition of this phenomenon may be helpful for the early diagnosis of sclerotic disease. Recent insights into the immunological consequences of minor skin injury may provide important clues to the underlying pathogenesis of cGVHD-mediated skin disease.
authors.affiliation: Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892, USA.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Martires
authors.forename: Kristin
authors.initials: K
authors.lastname: Baird
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Citrin
authors.forename: Fran T
authors.initials: FT
authors.lastname: Hakim
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
authors.forename: Edward W
authors.initials: EW
authors.lastname: Cowen
mesh_terms: D000328:Adult; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012594:Scleroderma, Localized / Q000473:pathology; D012598:Sclerosis; D012867:Skin / Q000293:injuries; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology*