Cutaneous Graft-Versus-Host Disease - Symptoms, Causes & Treatment
Medically reviewed by Dr. Anand S. Urhekar, MD, MD Pathology, Clinical Advisor · Last updated July 2026
A complication of allogeneic haematopoietic stem cell transplantation in which donor immune cells attack the recipient's skin. The acute form causes a red maculopapular rash typically starting on the palms, soles and ears; the chronic form produces lichen planus-like changes or progressive skin thickening and tightening.
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Quick Answer
Cutaneous graft-versus-host disease occurs when donor immune cells attack the skin after an allogeneic stem cell transplant. Acute GVHD causes a red rash starting on the palms, soles and ears within weeks, sometimes with diarrhoea and jaundice. Chronic GVHD causes lichen planus-like papules or progressive skin thickening and tightening. Treatment is corticosteroids plus specialist immunosuppression, alongside meticulous skin care and sun protection.
Symptoms
- Acute: red maculopapular rash on palms, soles, ears and neck
- Blistering and skin peeling in severe acute disease
- Chronic lichenoid: violaceous flat-topped papules
- Chronic sclerotic: thickened, tight, shiny skin restricting movement
- Associated dry eyes, mouth ulcers, nail and hair changes
Causes & Risk Factors
- Allogeneic haematopoietic stem cell transplantation
- Donor T-cells recognising recipient tissue as foreign
- Higher risk with HLA mismatch, older donor or recipient, and prior acute GVHD
- Rarely after transfusion of non-irradiated blood products
Treatment & Management
- Systemic and topical corticosteroids
- Calcineurin inhibitors, ruxolitinib and other specialist immunosuppression
- Extracorporeal photopheresis and phototherapy
- Emollients, gentle skin care and strict photoprotection
- Physiotherapy for sclerotic disease; long-term skin cancer surveillance
When to See a Doctor
Contact your transplant team promptly about any new rash, skin tightening, mouth ulceration or nail change after transplant. Early treatment of GVHD improves outcomes substantially.
Frequently Asked Questions
Does a rash after transplant always mean GVHD?
No. Drug reactions, infections and chemotherapy toxicity look similar. A skin biopsy alongside clinical assessment by the transplant team is used to distinguish them, because treatment differs sharply.
Why is sun protection so important?
Ultraviolet light can trigger and worsen GVHD flares, and long-term immunosuppression substantially raises skin cancer risk. Daily high-factor sunscreen and clothing cover are part of standard post-transplant care.
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.