Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease
Autor: | Kathryn J Martires, Yoo Jung Kim, Bernice Y. Kwong, Gun Ho Lee |
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Rok vydání: | 2019 |
Předmět: |
skin
medicine.medical_specialty Evidence-based practice medicine.medical_treatment Dermatology Hematopoietic stem cell transplantation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Quality of life immune system diseases hemic and lymphatic diseases Medicine Adverse effect chronic graft versus host disease (cgvhd) Transplantation therapy business.industry General Engineering Ultraviolet b medicine.disease hematopoietic stem cells chronic Calcineurin graft versus host disease (gvhd) Graft-versus-host disease Oncology hematopoietic stem cell transplantation business 030217 neurology & neurosurgery |
Zdroj: | Cureus |
ISSN: | 2168-8184 |
Popis: | 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. |
Databáze: | OpenAIRE |
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