Graft-versus-host disease (GVHD) is a complication that can develop after a bone marrow or stem cell transplant. It occurs when the donor’s immune cells mistakenly attack the tissue in the recipient’s body.
The initial symptoms of GVHD typically appear on the skin, often because GVHD first damages and causes inflammation in skin cells, says Azra Borogovac, MD, a hematologist at City of Hope in Irvine, California.
But because the donor cells can attack different layers of skin, it’s possible for the symptoms to look a little different from person to person.
Acute and Chronic GVHD Skin Symptoms
Skin issues can happen in both acute GVHD, which develops within the first few months of a transplant, and chronic GVHD, which develops more than 100 days after a transplant.
Up to 70 percent of people with acute GVHD will experience skin problems, including dry, itchy, or sensitive skin, along with rashes or redness of the feet and palms, says Dr. Borogovac.
About 60 to 80 percent of people with chronic GVHD will also have skin problems. “In chronic cases, the skin might feel hard or look darker in certain areas. Sometimes, sores or blistering can develop, too,” says Manish Gandhi, MD, a pathologist and the medical director of the transfusion laboratory at Mayo Clinic in Rochester, Minnesota. A GVHD rash usually resembles a sunburn and can form anywhere on the body.
Usually, a doctor can help you manage the symptoms of GVHD. If you’re experiencing mild symptoms, your transplant provider may be able to help treat them, but more severe symptoms — painful rashes or significant skin tightening — may require a dermatologist, says Dr. Gandhi.
Ways to Manage Skin Symptoms With GVHD
Lifestyle habits may be enough to manage GVHD in some cases, but in others, topical creams and medications can be prescribed. Here are a few things that can help your skin look and feel better:
1. Moisturize regularly. Apply moisturizer, especially after a shower or bath, to help keep your skin hydrated and ease itching. “Fragrance-free, gentle moisturizers can help reduce dryness and irritation,” says Gandhi. Ask your doctor for recommendations on particular moisturizers for your case.
2. Be diligent about sunscreen. People with chronic GVHD have a greater risk of developing nonmelanoma skin cancers — particularly, squamous cell carcinoma and basal cell carcinoma. To avoid this, stay out of the sun during peak hours and use sunscreen with an SPF of at least 30 daily, says Gandhi.
3. Stretch. If your skin or tissues are tight, use gentle stretching, massage, or physical therapy to help ease the tension. (But be careful not to overdo it: If you feel pain, stop immediately.)
4. Take care of wounds. Keep any sores clean and covered to help prevent infections. Talk to your doctor about which bandages are best for you.
5. Keep blood flowing. Keep skin healthy by maintaining good circulation through regular exercise, which can help provide skin cells with beneficial oxygen and nutrients and clear out impurities. Another helpful tip: Try not to cross your legs or sit for long periods of time, which can decrease blood flow to the leg.
6. Talk to your doctor about medication. In some cases, you may need medication to help manage GVHD-related skin symptoms. “These can include treatments to calm the immune response, reduce inflammation, or relieve itching and discomfort,” says Gandhi. Some of these medications include:
Antihistamine pills and corticosteroid creams for itchy skin
Immunosuppressants, such as prednisone, tacrolimus, or pimecrolimus, which can reduce redness and swelling, decrease sclerosis (hardening of tissue), and prevent new sclerosis. These medications can also cause skin thinning, though, so your doctor will likely prescribe them for a limited amount of time
7. Consider light therapy. If your skin is resistant to steroids, your transplant team may suggest extracorporeal photopheresis, a form of light therapy that involves extracting blood cells, exposing them to a photosensitizer and ultraviolet light, and then infusing the treated cells back into the body. This procedure can help keep immune cells from attacking your body, says Gandhi.
The Takeaway
Skin issues can occur in both acute and chronic GVHD and are very common.
GVHD-related skin issues can range from mild to severe, so work closely with your GVHD care team to manage and treat them.
Lifestyle changes, medications, and a type of light therapy can all help resolve the symptoms of GVHD.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Pugliese S. Graft-Versus-Host Disease: How It Affects Skin, Nails and Hair. BMT InfoNet. May 2, 2024.
Shi CR et al. Cutaneous Chronic Graft-Versus-Host Disease: Clinical Manifestations, Diagnosis, Management, and Supportive Care. Transplantation and Cellular Therapy. September 2024.
Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.
She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.
Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.
Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
