Impact of skin biopsy on the management of acute graft-versus-host disease in a pediatric population

Hilary Haimes, Keith W. Morley, Hannah Song, Jean Phillip Okhovat, Birgitta Schmidt, Jennifer T. Huang

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background/Objectives: Acute graft-versus-host disease (GVHD) of the skin is a common complication of hematopoietic stem cell transplantation (HSCT) but often represents a diagnostic challenge. The adult literature suggests that histopathology rarely dictates management decisions, but the clinical utility of skin biopsies in pediatric patients with suspected acute GVHD is unknown. The objective of this study was to determine the frequency with which skin biopsy leads to a definitive diagnosis of acute GVHD and changes the management of acute GVHD in the pediatric population. Methods: We conducted a retrospective analysis of histopathology results and the associated impact on clinical management based on chart review of pediatric patients who underwent skin biopsy for cutaneous eruptions suspicious for acute GVHD from 1995 to 2016. Results: Among 27 pediatric HSCT patients, skin biopsy yielded definitive diagnoses (GVHD or otherwise) in only 15% (4/27) of cases. Overall, dermatology consultation was associated with clinical management changes in 78% (21/27) of cases. A change in management was definitively based on skin biopsy results in only 7.4% (2/27) of cases. The mean duration of time between dermatology consultation and return of biopsy results was 4.8 days (range 1-17). Conclusions: Our results suggest that skin biopsy of pediatric HSCT patients with findings concerning for acute skin GVHD rarely yields a definitive diagnosis or change in management.

Original languageEnglish
Pages (from-to)455-459
Number of pages5
JournalPediatric Dermatology
Volume36
Issue number4
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

Keywords

  • dermatopathology
  • skin signs of systemic illness

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