High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease

Čeović, Romana and Desnica, Lana and Pulanić, Dražen and Serventi Seiwerth, Ranka and Ilić, Ivana and Grce, Magdalena and Mravak Stipetić, Marinka and Klepac Pulanić, Tajana and Bilić, Ervina and Bilić, Ernest and Milošević, Milan and Vrhovac, Radovan and Nemet, Damir and Pavletic, Steven Z (2016) High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease. Croatian Medical Journal, 57 (3). pp. 229-238. ISSN 0353-9504

PDF - Published Version Download (2MB)

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.

Abstract in Croatian

Visoka učestalost kožnih manifestacija, uključujući vitiligo i alopeciju areatu, u prospektivno prikupljenoj skupini pacijenata s kroničnom bolešću presatka protiv domaćina ----- Cilj: Odrediti učestalost i obilježja kožnih manifestacija, posebice vitiliga i alopecije areate, kod pacijenata s kroničnom bolešću presatka protiv domaćina (prema engl. chronic graft-versus-host disease, cGVHD). ----- Postupci: Opservacijsko istraživanje prospektivno je uključilo 50 pacijenata s cGVHD koje je pregledao iskusni dermatolog. Evaluacija je bila usmjerena na kliničke znakove zahvaćenosti kože i adneksa te je utvrđen kožni GVHD izračun prema kriterijima Nacionalnih instituta za zdravlje SAD-a (prema engl. National Institutes of Health, NIH). Odredili smo prisutnost vitiliga, alopecije, kseroze, promjena noktiju i depigmentacije. ----- Rezultati: Od 50 cGVHD pacijenata, 28 (56%) je imalo zahvaćenu kožu, dok je 27 od njih (96%) imalo hipo i/ili hiperpigmentacije. Prema kožnom NIH cGVHD izračunu, 11 pacijenata (39%) imalo je blagi oblik bolesti, 22% umjereni, a 39% teški oblik bolesti. 15 (30%) pacijenata imalo je promjene noktiju, dok ih je 10 (20%) imalo vitiligo ili alopeciju areatu. Univarijatna analiza pokazala je da su pacijenti s vitiligom/alopecijom areatom primili više linija sustavne imunosupresivne terapije (P=0,043), imali niži Karnofsky izvedbeni status (P=0,028) te veći broj B limfocita (P=0,005), trombocita (P=0,022) i ukupnih proteina (P=0,024). Vitiligo i alopecija areata bili su povezani s višim NIH kožnim izračunom (P=0,001), većim intenzitetom imunosupresivne terapije (P=0,020) i zračenjem cijelog tijela (P=0,040). Multivarijatni regresijski model pokazao je da su pacijenti s višim NIH kožnim izračunom imali 3,67 puta veće izglede da dobiju alopeciju i/ili vitiligo (omjer izgleda 3,67; 95% raspon pouzdanosti 1,26-10,73), uz kontroliranje svih ostalih čimbenika u modelu (dob pri uključenju u istraživanje, broj B stanica, broj krvnih pločica, i ukupni NIH izračun). ----- Zaključak: Naši podaci pokazali su veći broj cGVHD pacijenata s vitiligom i alopecijom nego što je to ranije opaženo.

Actions (login required)

View Item

Downloads