Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease.

Autor:	Kim YJ; Department of Dermatology, Stanford University School of Medicine, Stanford, USA., Lee GH; Department of Dermatology, Stanford University School of Medicine, Stanford, USA., Kwong BY; Department of Dermatology, Stanford University School of Medicine, Stanford, USA., Martires KJ; Department of Dermatology, Palo Alto Medical Foundation, San Jose, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2019 Dec 25; Vol. 11 (12), pp. e6462. Date of Electronic Publication: 2019 Dec 25.
DOI:	10.7759/cureus.6462
Abstrakt:	Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHD and long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHD and may decrease the amount of systemic immunosuppression required. This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skin-directed treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available. Twenty-two out of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least 26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remission and four out of 14 patients (28.6%) experienced partial remission. As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2019, Kim et al.)
Databáze:	MEDLINE
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