Skin
Therapy
Graft vs Host Disease (GvHD)
Prevention:
- Cyclosporine
- Since 1980 cyclosporine has replaced methotrexate MTX for the prophylaxis and treatment of GvHD
- Reduces severity of condition and not incidence
- Tacrolimus and methotrexate
Therapy of Acute Graft versus Host:
- Supportive Care
- Prednisone at 2 mg. per kg. which may be combined with cyclosporine
- The addition of anti-thymocyte globulin may be of value
- Refractory cases may be helped by monoclonal antibodies to cytokines and cytokine receptors
Chronic Graft versus Host:
- Treated with cyclosporine and systemic steroids and topical corticosteroids
- Tacrolimus and mycophenolate mofetil may also be of value
- PUVA has also been used to treat GvHD (may be associated with an increased risk of second malignancy as a late effect)
RT induced skin damage:
- Acute reactions are usually a self limiting problem after a standard RT6
- Topical corticosteroids can give symptomatic benefit
- Topical flamazine can be very helpful for severe reactions associated with moist desquamation
- Careful wound care is used to promote re-epithelialization from the RT field edges
- Some data shows that a combination of tocopherol (vitamin E) and pentoxifylline (Trental) may be useful in the treating of RT induced fibrosis6
- Hyperbaric oxygen can be used as an alternative strategy to promote healing of skin ulcerations6
- Surgical management with skin grafting of the irradiated area may be a last resort in very severe cases of skin injury6. This surgery would likely be associated with significant wound healing problems - hyperbaric oxygen would likely be beneficial before and after surgery.
