Skin inflammatory (nontumor)
Lichenoid and interface reaction patterns
Graft versus host disease

Author: Mowafak Hamodat, M.D., M.Sc. (see Authors page)

Revised: 15 October 2018, last major update July 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Graft versus host disease [title] skin

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Cite this page: Hamodat, M. Graft versus host disease. website. Accessed February 19th, 2019.
Clinical features
  • Important cause of post-bone marrow transplant morbidity; usually occurs 10 - 30 days after allogeneic bone marrow transplant
  • Due to immunocompetent donor lymphocytes reacting against recipient tissues, causing cutaneous, hepatic and intestinal lesions
  • Prognosis is related to amount of inflammation
  • Initially is a pruritic maculopapular skin rash, often on acral surfaces and pinnae
  • May progress to diffuse eruption on trunk and extremities with oral mucosal stomatitis and ulceration

  • Chronic GVHD: develops 100 days after transplant (DermNetNZ)
Microscopic (histologic) description
  • Early: basal layer vacuolization and necrosis, spongiosis, apoptosis, acantholysis, chronic inflammation of upper dermis with perivascular lymphocytic infiltrate and intraepidermal lymphocytes; follicular involvement is a common feature
  • Late stage - lichenoid type: hyperkeratosis, hypergranulosis, irregular acanthosis, basal cell hydropic changes, cytoid body formation, pigment incontinence, and band like lymphohistiocytic infiltrate; in contrast to idiopathic lichen planus, satellite cell necrosis is often present in the early phase of chronic GVHD, and the infiltrate sometimes contains plasma cells and eosinophils
  • Late stage of chronic GVHD: characterized by epidermal atrophy, with abolition of ridge pattern and scarring of superficial and deep dermis, with loss of adnexal structures; features are similar to scleroderma
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Amy Lynn, M.D.
Positive stains
  • IgM deposition (granular or linear) in basement membrane zone
Differential diagnosis
  • Lichenoid chronic GVHD: resembles lichen planus, but LP lacks satellite cell necrosis, plasma cells or eosinophils
  • Late stage chronic GVHD: resembles scleroderma, but clinical history is different
Additional references