Cutaneous graft-versus-host disease: From acute reactions to chronic sequelae

Graft-versus-host disease (GVHD) is a frequent immune-mediated complication following allogeneic hematopoietic stem cell transplantation (HSCT), caused by a fundamental function of the immune system – the ability to distinguish between self and non-self. As a multi-systemic disorder, GVHD is characterized by tissue inflammation and fibrosis, primarily affecting the skin and mucosal surface, gastrointestinal tract, liver, and lungs. Given the potential involvement of multiple organs, a wide spectrum of clinical manifestations may be observed. Since cutaneous and mucosal manifestations are not only the most frequent finding in GVHD, but often the earliest and most clinically apparent, dermatologists play a critical role in early recognition and diagnosis. The cutaneous involvement can be complex and diagnostically challenging. This review aims to provide a comprehensive overview of the diverse skin manifestations in acute and chronic GVHD to facilitate a correct and timely diagnosis. Furthermore, we summarize current therapeutic options for GVHD subtypes to support appropriate treatment and optimize clinical outcomes.