Table 3.

Ancillary Therapy and Supportive Care Recommendations for Skin GVHD

Type of Intervention	Recommendation Rating
Preventive measures
Photoprotection: UVA and UVB blockade including:
Avoidance of sun exposure (especially between 10:00 am and 4:00 pm)	AIII
Use of sunscreens (>SPF 20 with broad-spectrum UVA and UVB protection)	AIII
Protective clothing	AIII
Avoidance of photosensitizing agents	AIII
Treatment
Intact skin
Symptomatic treatment with emollients and antipruritic agents	AIII
Topical corticosteroids	CIIb
Light therapy (PUVA, UVA1, UVB, narrow-band UVB)	CIIa
Topical calcineurin inhibitors (pimecrolimus, tacrolimus)	CIIa
Sclerotic manifestations with joint stiffness or contractures
Deep muscle/fascial massage (Heller works) to improve ROM	CIII
Stretching exercises to improve ROM	BIII
Erosions and ulcerations
Topical or oral antimicrobials	BIII
Wound dressings and debridement	CIII
Control of edema	BIII
PEDIATRIC CONSIDERATIONS Systemic side effects of topical steroids and topical calcineurin inhibitors may occur more frequently in young children because of the larger skin surface area to body weight ratio. Although the least potent topical steroids (1% to 2.5% hydrocortisone) are safe, middle to upper mid-strength topical steroids should generally be used sparingly, and on limited areas, for no more than 3 to 4 wk. Topical steroids under occlusive dressings are not recommended. The use of potent or super-potent steroids on the face, or at any site in infants <1 yr of age, is not recommended. Avoid urea or menthol containing products in young children because they may cause skin irritation.

SPF indicates sun protective factor; PUVA, photochemotherapy.