Lichenoid chronic GvHD following Blaschko lines is a rare variant of chronic, localized GvHD.Two patterns of distribution of localized chronic GvHD have been reported in the literature: Blaschko-linear and dermatomal; this last one corresponding to the area of previous zoster infection.Sanli et al.3 described a patient who developed lichenoid GvHD after herpes zoster infection involving the right neck, shoulder, chest, and scapular area, corresponding to the C3–C4 dermatomes. In post-zoster lichenoid GvHD, it has been hypothe- sized that viral proteins could play a role by altering the surface antigenicity of keratinocytes, thus triggering hypersensitivity reactions at these loci minoris resistentiae, as better documented in other dermatoses developed after a previous herpes zoster infection.3,6,7 The linear or whorled distribution following Blaschko lines, as in our case, could be better explained by the unmasking of a genetic mosaicism due to the donor’s lymphocytes and previously tolerated by the patient’s own lymphocytes.8 This hypothesis is also supported by Happle, who emphasizes the Blaschko-linear rather than dermatomalarrangement of localized GvHD and defines this disorder as polygenic, thus suggesting the preferable definition of a superimposed segmental manifestation. This implies that a segmental involvement could precede the appearance of non-segmental lesions, which fortunately did not happen in our reported case.9

Lichenoid cutaneous chronic GvHD following Blaschko lines.

DERLINO, FEDERICA;BORRONI, GIOVANNI
2013-01-01

Abstract

Lichenoid chronic GvHD following Blaschko lines is a rare variant of chronic, localized GvHD.Two patterns of distribution of localized chronic GvHD have been reported in the literature: Blaschko-linear and dermatomal; this last one corresponding to the area of previous zoster infection.Sanli et al.3 described a patient who developed lichenoid GvHD after herpes zoster infection involving the right neck, shoulder, chest, and scapular area, corresponding to the C3–C4 dermatomes. In post-zoster lichenoid GvHD, it has been hypothe- sized that viral proteins could play a role by altering the surface antigenicity of keratinocytes, thus triggering hypersensitivity reactions at these loci minoris resistentiae, as better documented in other dermatoses developed after a previous herpes zoster infection.3,6,7 The linear or whorled distribution following Blaschko lines, as in our case, could be better explained by the unmasking of a genetic mosaicism due to the donor’s lymphocytes and previously tolerated by the patient’s own lymphocytes.8 This hypothesis is also supported by Happle, who emphasizes the Blaschko-linear rather than dermatomalarrangement of localized GvHD and defines this disorder as polygenic, thus suggesting the preferable definition of a superimposed segmental manifestation. This implies that a segmental involvement could precede the appearance of non-segmental lesions, which fortunately did not happen in our reported case.9
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11571/829035
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 3
social impact