Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Skin Manifestations in Graft-Versus-Host-Disease

J Am Acad Dermatol; 2018 Jun; Kim, Schmelkin, et al

Graft-versus-host-disease (GVHD) is a potentially fatal condition that can occur after solid organ transplantation (SOT) and often presents with a skin rash. Upon conducting a systematic literature review of SOT GVHD, investigators recommend that dermatologists have a low threshold to consider and pursue this diagnosis in the setting of post-SOT skin eruption.

The review included 61 articles, representing 115 patients and 126 transplanted organs. Key points include:

  • The most commonly transplanted organ was the liver (n=81).
  • Among total patients, 101 (87.8%) developed skin involvement.
  • The eruption appeared an average of 48.3 days (range, 3-243 days) posttransplant and was pruritic in 5 of 101 (4.9%) cases.
  • The eruption was described as morbilliform in 2 patients (1.9%), confluent in 6 (5.9%), and desquamative in 4 (3.9%) cases.
  • The mortality rate was 72.2%.
  • Relative time of death was reported in 23 patients who died during the follow-up period; they died an average of 99.2 days (range, 22-270 days) posttransplant, or 50.9 days after the appearance of dermatologic symptoms.
  • Frequent causes of death were sepsis and multiorgan failure.


Kim GY, Schmelkin LA, Davis MDP, et al. Dermatologic manifestations of solid organ transplantation–associated graft-versus-host disease: A systematic review. J Am Acad Dermatol. 2018;78(6):1097-1101.e1. doi:10.1016/j.jaad.2017.12.050.

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