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Abstract

Background: Because most chronic graft-versus-host disease (cGVHD) research is published outside the dermatology/dermatopathology literature, precise morphologic characterization is lacking. This retrospective case series aimed to characterize clinicopathologic features of psoriasiform cGVHD, a rare subtype. Methods: We identified patients with clinicopathologic evidence of psoriasiform cGVHD in patients via an electronic medical record search (2000-2025). We reviewed their charts, photographs, and representative biopsy specimen. Patients with known pre-transplantation psoriasis were excluded. Results: Among 12 patients (mean age 52 years, range 23–71 years), 11 (92%) had a prior history of acute GVHD. Median time from transplantation to onset of psoriasiform cGVHD was 43 months (range, 10–242 months). Prior cutaneous cGVHD was present in 10 (83%), mainly as lichenoid (n=9; 75%) or sclerotic changes (n=1; 8%).  Nine patients (75%) had extracutaneous organ involvement. Clinical morphologies included plaques (n=5; 42%), guttate lesions (n=5), or erythroderma (n=2; 16%). No patients had documented psoriatic nail involvement. One developed inflammatory arthritis three months after psoriasiform lesion onset. Of 12 skin biopsies, all showed hyperparakeratosis and reduced/absent granular layer. Munro microabscesses were seen in 3 (25%). Dyskeratotic keratinocytes were present in 9 (75%), while interface inflammation was seen in 2 (17%).  No cases showed sclerosis. During the follow-up period (median 42 months, range 1–192 months), psoriasiform lesions resolved in 7 (58%) patients, and sclerotic disease developed in 1. Conclusion: Though psoriasiform cGVHD can mimic idiopathic psoriasis clinically, it can have distinct histopathologic features. Further research on whether psoriasiform cGVHD correlates with prognosis is needed.