10.5826/dpc.1303a189
text/xml
2160-9381
3030
en
Jeenu  Varghese
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Successful Treatment of Morpheaform Graft-Versus-Host Disease: A Dermoscopic Follow-up of 1 Year
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-11-27
2023-07-31
2023-08-24
e2023189
Dermatol Pract Concept
Jeenu  Varghese
2023/07/31
10.5826/dpc.1303a189
e2023189
Pathology, Command Hospital Air Force, Bengaluru, India
2160-9381
en
e2023189
Kaminska-Winciorek G, Zalaudek I, Mendrek W, Jaworska M, Gajda M, Hołowiecki J, Szymszal J, Giebel S. Dermoscopy of Cutaneous Graft-Versus-Host-Disease in Patients After Allogeneic Hematopoietic Stem Cell Transplantation. Dermatol Ther (Heidelb). 2020;10(5):1043-1061.
Successful Treatment of Morpheaform Graft-Versus-Host Disease: A Dermoscopic Follow-up of 1 Year
https://dpcj.org/index.php/dpc/article/download/3030/2244
               Successful Treatment of Morpheaform
             Graft-Versus-Host Disease: A Dermoscopic
                        Follow-up of 1 Year
      Rohit Kothari1, Shekhar Neema2, Anuj Bhatnagar1, Karthi Kishore1, Jeenu Varghese3


1 Dermatology, Command Hospital Air Force, Bengaluru, India
2 Dermatology, Armed Forces Medical College, Pune, India
3 Pathology, Command Hospital Air Force, Bengaluru, India



Citation: Kothari R, Neema S, Bhatnagar A, Kishore K, Varghese J. Successful Treatment of Morpheaform Graft-Versus-Host Disease: A
Dermoscopic Follow-up of 1 Year. Dermatol Pract Concept. 2023;13(3):e2023189. DOI: https://doi.org/10.5826/dpc.1303a189
Accepted: March 16, 2023; Published: July 2023
Copyright: ©2023 Kothari et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Rohit Kothari, Assistant Professor, Dermatology, Command Hospital Air Force, Bengaluru, Cambridge Road,
Agram post, India-560007. Telephone: (+91) 9660650747 E-mail: rohitkothari3422@gmail.com




Case Presentation                                                             He was managed with super-potent topical corticoste-
                                                                         roids (TCS) twice daily for 6 months and once-daily there-
A 40-year-old male underwent hematopoietic stem cell                     after following favorable response. Follow-up at 1-year
transplant (HSCT) for acute myeloid leukemia. He presented               revealed completely regressed lesion without any indura-
with itching, erythema, and induration over the anterome-                tion or erythema (Figure 1C). Repeat skin biopsy did not
dial thigh (Figure 1A), one-year post-HSCT. Dermoscopy re-               show any features of GVHD. Dermoscopy revealed reso-
vealed background erythema, prominent pigment network,                   lution of erythema and scaling signifying settled inflam-
perifollicular blue-gray and whitish structureless areas, scal-          mation, telangiectasias due to potent TCS use, peppering,
ing, and reduced hair-follicles (Figure 1B). Histopathology              and prominent white structureless areas due to fibrosis
showed orthokeratosis, mild acanthosis, basal cell vacuolar              (Figure 1D).
degeneration, and mild lichenoid lymphocytic infiltrate in
the interface. Superficial and deep dermis showed parallelly
                                                                         Teaching Point
arranged thickened collagen bundles and mild lymphocytic
perivascular inflammation with melanophages (Supplemen-                  The dermoscopic features of localized morpheaform GVHD
tary Figure). The background erythema, prominent pigment                 are not well established. Kaminska et al described granu-
network, and perifollicular blue-grey and whitish structure-             larity, rhomboidal pigment arrangement, mild scaling, and
less areas on dermoscopy corresponds to lymphocytic in-                  white patchy areas; however, no follow-up dermoscopy was
flammation, melanophages, lichenoid infiltrate and collagen              performed [1]. We found that follow-up dermoscopy may
bundles, respectively. He was diagnosed as localized mor-                give an important clue regarding the treatment response. The
pheaform graft-versus-host disease (GVHD).                               disappearance of erythema and scaling, prominent white



Image Letter | Dermatol Pract Concept. 2023;13(3):e2023189                                                                           1
         Figure 1. (A) Localized morpheaform graft-versus-host disease showing erythema and induration over anteromedial
         thigh. (B) Dermoscopy (Illuco IDS-1100, polarized 10x) showing background erythema, prominent pigment network,
         perifollicular blue-gray (black circles) and whitish structureless areas (red circles), scaling, and reduced hair-follicles.
         (C) Follow-up at 1-year showing completely regressed lesion with post-inflammatory hyperpigmentation. (D) Der-
         moscopy (Illuco IDS-1100, polarized 10x) showing telangiectasias (arrows), peppering (circle), and white structureless
         areas (stars).




structureless areas and appearance of peppering signified ad-            References
equate treatment response in our patient.
                                                                          1. Kaminska-Winciorek G, Zalaudek I, Mendrek W, Jaworska M,
                                                                             Gajda M, Hołowiecki J, Szymszal J, Giebel S. Dermoscopy of
                                                                             Cutaneous Graft-Versus-Host-Disease in Patients After Alloge-
                                                                             neic Hematopoietic Stem Cell Transplantation. Dermatol Ther
                                                                             (Heidelb). 2020;10(5):1043-1061. DOI: 10.1007/s13555-020-
                                                                             00423-6. PMID: 32676797. PMCID: PMC7477036.




2                                                                               Image Letter | Dermatol Pract Concept. 2023;13(3):e2023189
