The overall prevalence of chronic graft-versus-host disease-related alopecia and nail dystrophy

In September 2018, Jason S. Naftulin from Massachusetts General Hospital, Department of Dermatology, Boston, MA, USA, and colleagues published a correspondence in Bone Marrow Transplantation discussing the overall prevalence of chronic graft-versus-host disease (cGvHD) related alopecia and nail dystrophy.

The authors conducted a retrospective, case–controlled study analyzing adult patients who previously underwent hematopoietic stem cell transplantation (HSCT) and developed skin cGvHD to evaluate the prevalence of hair and nail changes in skin cGvHD and to determine the predictive value of adnexal involvement of more extensive and severe overall cGvHD.

Four hundred and seventy-four patients were included in the study.

• N = 193 had cutaneous GvHD, of these, n = 163 had skin cGvHD
• Patients were divided into four groups:
  • Group 1 (n = 32): hair and nail changes confirmed to be associated with cGvHD and with adnexal involvement
  • Group 2 (n = 40): minimal hair and nail changes and unclear association with cGvHD
  • Group 3 (n = 33): no confirmed presence or absence of hair and nail changes
  • Group 4 (n = 58): confirmed absence of hair and/or nail findings

Key findings:

• Group 1
  • Patients had hair changes related to cGvHD: n =14 (43.8%)
  • Patients had nail changes related to cGvHD: n = 16 (50%)
  • Two patients (6.3%) had both nail and hair changes related to cGvHD
  • Organs affected by GvHD in Group 1 were predominantly the oral mucosa (62.5%) and eyes (56.5%)
• Group 1 had more organ systems affected, with an average of 2.0 (± 1.2) organ involvements compared with Groups 2–4 with an average of 1.3 (± 1.2) organ systems affected, P = 0.004
• Patients with hair and/or nail cGvHD in Group 1 were more likely to have sclerotic skin cGvHD than the 34.4% of patients with sclerotic skin cGvHD in Groups 2–4: 65.6% vs 34.4%, P = 0.002; and 65.6% vs 41.4% in Group 4, P = 0.046
• Group 1 patients had a significantly higher rate of oral mucosal cGvHD and ocular cGvHD than patients in Groups 2–4: 62.5% vs 27.5%, P ≤ 0.001, and 56.3% vs 28.2%, P = 0.004, respectively

In summary, this study indicates that closer monitoring may be mandatory in patients with cGvHD with longstanding adnexal findings for earlier intervention of ocular and oral mucosal GvHD. The authors recommended “the routine examination and recording of adnexal findings by all practitioners who care for cGvHD patients, regardless of whether hair loss and nail changes are brought up as patient complaints, to perhaps provide better overall outcomes for these patients.” Further prospective studies are required to confirm these findings.