title: Isomorphic sclerotic-type cutaneous chronic graft-versus-host disease: report and review of chronic graft-versus-host disease in a cutaneous immunocompromised district.
abstract: BACKGROUND
  Patients who have received a hematopoietic cell transplantation can develop graft-versus-host disease (GVHD). The liver, the gastrointestinal tract, and/or the skin can be affected by GVHD. Chronic sclerotic-type cutaneous GVHD can occur at sites of repetitive skin friction.
  
  
  OBJECTIVE
  To describe isomorphic sclerotic-type GVHD and review chronic GVHD appearing in a cutaneous immunocompromised district.
  
  
  METHODS
  The clinical features of a 74-year-old man with mantle cell lymphoma who developed chronic sclerotic-type cutaneous GVHD localized to the waistband area-which had been exposed to repetitive skin injury-after a second hematopoietic cell transplantation are reported. Using the PubMed database, an extensive literature search was performed on chronic GVHD.
  
  
  METHODS
  The cutaneous immunocompromised district is an area of skin whose local effective immunity has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor at the site. A cutaneous isomorphic response refers to a disease-associated skin lesion occurring at the site of physical injury that is morphologically similar to the existing condition. Cutaneous chronic GVHD can occur at sites of repetitive skin trauma as an isomorphic response. The patient developed sclerotic-type GVHD in a cutaneous area that had previously experienced repeated irritation, friction, and pressure. Isomorphic sclerotic-type GVHD-in either the waistband area or brassiere area or both-has also been observed in other patients. In addition, cutaneous chronic GVHD has been described not only at the location of a previous, unrelated, and healed skin disease as an isotopic response, but also at the cutaneous site of earlier exposure to radiotherapy or ultraviolet radiation as an isoradiotopic response.
  
  
  CONCLUSIONS
  Sclerotic and nonsclerotic skin lesions of chronic GVHD can occur not only as an isomorphic response, but also as either an isotopic response or an isoradiotopic response in a cutaneous immunocompromised district.
authors: Division of Dermatology, University of California San Diego, San Diego, CA, USA, mitehead@gmail.com.
authors: Philip R
authors: PR
authors: Cohen