Original scientific paper
https://doi.org/10.3325/cmj.2016.57.229
High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease
Romana Čeović
; Department of Dermatology and Venereology University Hospital Centre Zagreb, Zagreb, Croatia
Lana Desnica
; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Dražen Pulanić
; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ranka Serventi Seiwerth
; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ivana Ilić
; Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
Magdalena Grce
; Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
Marinka Mravak Stipetić
; University of Zagreb, School of Dental Medicine, Zagreb, Croatia
Tajana Klepac Pulanić
; Department of Gynecology, Community Health Center Zagreb East, Zagreb, Croatia
Ervina Bilić
; University of Zagreb School of Medicine, Zagreb, Croatia
Ernest Bilić
; University of Zagreb School of Medicine, Zagreb, Croatia
Milan Milošević
; University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
Radovan Vrhovac
; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Damir Nemet
; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Steven Z Pavletic
; Experimental Transplantation & Immunology Branch,Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
Abstract
Aim 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).
Conclusion These data indicate that vitiligo and alopecia
areata occur more frequently in cGVHD than previously reported.
Keywords
Hrčak ID:
169600
URI
Publication date:
15.6.2016.
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