Nonmalignant late cutaneous changes after allogeneic hematopoietic stem cell transplant in children

Background: There are limited pediatric data on nonmalignant cutaneous changes, including autoimmune conditions and permanent alopecia, after hematopoietic stem cell transplantation (HSCT). Objective: We sought to characterize late cutaneous changes and associated risk factors after allogeneic HSCT in children. Methods: A cross-sectional cohort study of pediatric HSCT recipients was performed at a single institution. All participants underwent a full skin examination. Results: The median visit age was 13.8 years, with a median time post-HSCT of 3.6 years. Of 85 patients, 14% (n = 12) had vitiligo, 16% (n = 14) had psoriasis/sebopsoriasis, 25% (n = 21) had alopecia, and 6% (n = 5) had nail changes. Factors significantly associated with vitiligo included a history of chronic graft-versus-host disease (cGVHD), transplant indication of primary immunodeficiency, and younger age at transplant (<10 years of age). Fifty-two percent of patients with alopecia had androgenetic alopecia patterns. Factors significantly associated with alopecia included cGVHD, busulfan conditioning, and family history of early male pattern alopecia. All patients with nail changes had cGVHD. Limitations: The cross-sectional design did not allow time of onset identification. Histopathologic correlation was not performed. Conclusion: Pediatric HSCT recipients, particularly those with cGVHD, are at risk for developing nonmalignant late cutaneous changes.