title: Skin ulcers related to chronic graft-versus-host disease: clinical findings and associated morbidity.
abstract: BACKGROUND
  According to the National Institutes of Health classification of chronic graft-versus-host disease (cGVHD), skin ulcers after allogeneic haematopoietic stem-cell transplantation (HSCT) are recorded as having the maximal severity score but published data are scarce.
  
  
  OBJECTIVE
  To describe skin ulcers related to cGVHD with an emphasis on clinical findings, associated morbidity, management and evolution.
  
  
  METHODS
  A multicentre retrospective analysis was carried out of patients with a diagnosis of cGVHD skin ulcers.
  
  
  RESULTS
  All 25 patients included in the study had sclerotic skin cGVHD and 21 had lichenoid skin lesions associated with the sclerotic skin lesions. Thirteen patients had severe cGVHD without considering the skin, because of the involvement of an extracutaneous organ by cGVHD. The median time from HSCT to the onset of ulcers was 44 months. In addition to scleroderma, initial skin lesions at the site of ulcers were bullous erosive lichen in 21 patients and bullous erosive morphoea in four patients. Fifteen patients had an inaugural oedema. Ulcers were mostly bilateral with a predilection for the lower limbs. They were frequently colonized but few infections occurred. Four patients died during a median follow-up period of 55 months.
  
  
  CONCLUSIONS
  Chronic graft-versus-host disease skin ulcers occur in patients with sclerodermatous skin cGVHD, are associated with severe cGVHD, often start with bullous lichenoid lesions or bullous morphoea and seem to cause more morbidity than mortality, given the low rate of mortality observed in our series of patients.
authors.affiliation: Department of Dermatology, AP-HP, Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Jachiet
authors.forename: A
authors.initials: A
authors.lastname: de Masson
authors.forename: R
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: M
authors.initials: M
authors.lastname: Rybojad
authors.forename: M
authors.initials: M
authors.lastname: Robin
authors.forename: J-H
authors.initials: JH
authors.lastname: Bourhis
authors.forename: A
authors.initials: A
authors.lastname: Xhaard
authors.forename: N
authors.initials: N
authors.lastname: Dhedin
authors.forename: F
authors.initials: F
authors.lastname: Sicre de Fontbrune
authors.forename: F
authors.initials: F
authors.lastname: Suarez
authors.forename: S
authors.initials: S
authors.lastname: Barete
authors.forename: N
authors.initials: N
authors.lastname: Parquet
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.forename: L
authors.initials: L
authors.lastname: Ades
authors.forename: M-T
authors.initials: MT
authors.lastname: Rubio
authors.forename: S
authors.initials: S
authors.lastname: Wittnebel
authors.forename: M
authors.initials: M
authors.lastname: Bagot
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.forename: J-D
authors.initials: JD
authors.lastname: Bouaziz
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012598:Sclerosis / Q000473:pathology; D012867:Skin / Q000473:pathology*; D012883:Skin Ulcer / Q000209:etiology* / Q000473:pathology; D014184:Transplantation, Homologous; D055815:Young Adult