title: High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease.
abstract: OBJECTIVE
  To determine the frequency and the characteristics of cutaneous manifestations, especially vitiligo and alopecia areata, in patients with chronic graft-vs-host disease (cGVHD).
  
  
  METHODS
  50 patients with cGVHD were prospectively enrolled in the observational study protocol and evaluated by an experienced dermatologist. The evaluation was focused on the clinical spectrum of skin and adnexal involvement, and the cutaneous GVHD score was determined according to National Institutes of Health (NIH) Consensus criteria. The presence of vitiligo, alopecia, xerosis, nail changes, and dyspigmentation was also assessed.
  
  
  RESULTS
  Out of 50 cGVHD patients, 28 (56%) had skin involvement, and 27 of them (96%) had hypo and/or hyperpigmentations. 11 patients (39%) had a mild cutaneous NIH cGVHD score, 22% moderate, and 39% severe. 15 (30%) patients had nail changes and 10 (20%) had vitiligo or alopecia areata. Univariate analysis showed that patients with vitiligo/alopecia areata received more lines of prior systemic immunosuppressive therapy (P=0.043), had lower Karnofsky performance status (P=0.028), and had a higher B-cell number (P=0.005), platelet count (P=0.022), and total protein (P=0.024). Vitiligo and alopecia areata were associated with higher NIH skin score (P=0.001), higher intensity of immunosuppressive treatment (P=0.020), and total body irradiation conditioning (P=0.040). Multivariate regression model showed that patients with higher NIH skin scoring were 3.67 times more likely to have alopecia and/or vitiligo (odds ratio 3.67; 95% confidence interval 1.26-10.73), controlled for all other factors in the model (age at study entry, number of B-cells, platelet count, and global NIH score).
  
  
  CONCLUSIONS
  These data indicate that vitiligo and alopecia areata occur more frequently in cGVHD than previously reported.
authors.affiliation: Romana Čeović, Department of Dermatology and Venereology, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Šalata 4, HR-10000 Zagreb, Croatia, romana.ceovic@zg.t-com.hr.
authors.forename: Romana
authors.initials: R
authors.lastname: Čeović
authors.forename: Lana
authors.initials: L
authors.lastname: Desnica
authors.forename: Dražen
authors.initials: D
authors.lastname: Pulanić
authors.forename: Ranka
authors.initials: R
authors.lastname: Serventi Seiwerth
authors.forename: Ivana
authors.initials: I
authors.lastname: Ilić
authors.forename: Magdalena
authors.initials: M
authors.lastname: Grce
authors.forename: Marinka
authors.initials: M
authors.lastname: Mravak Stipetić
authors.forename: Tajana
authors.initials: T
authors.lastname: Klepac Pulanić
authors.forename: Ervina
authors.initials: E
authors.lastname: Bilić
authors.forename: Ernest
authors.initials: E
authors.lastname: Bilić
authors.forename: Milan
authors.initials: M
authors.lastname: Milošević
authors.forename: Radovan
authors.initials: R
authors.lastname: Vrhovac
authors.forename: Damir
authors.initials: D
authors.lastname: Nemet
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000506:Alopecia Areata / Q000139:chemically induced / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014184:Transplantation, Homologous; D014820:Vitiligo / Q000139:chemically induced / Q000150:complications*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents