Table 1.

Supportive care recommendations for chronic GVHD of the skin

Preventative measures

Photoprotection (UVA and UVB blockade)  Avoidance of sun exposure  Use of sunscreens (≥SPF 20 with broad-spectrum UVA and UVB protection)

Treatment

Intact skin     Symptomatic treatments with emollients and antipruritic agents     Topical corticosteroids     Light therapy (PUVA, UVAI, UVB, narrowband UVB)     Topical calcineurin inhibitors (pimecrolimus, tacrolimus)

Erosion and ulcerations     Wound dressings and debridement     Control of edema

Sclerotic manifestation with joint stiffness or contractures     Deep muscle/fascial massage to improve range of motion     Referral to physical therapy, occupational therapy, or physical medicine and rehabilitation     Daily stretching exercises to improve range of motion     Strengthening, isotonic, isometric, and isokinetic exercises

Other     Dyspigmentation: trial of depigmenting creams containing hydroquinone, topical tretinoin, or corticosteroids     Hair loss: dermovate scalp lotion once or twice daily     Xerosis: regular moisturizers     Pruritus: tepid water rather than hot water for bathing, topical corticosteroids, oral antihistamines, doxepin, or gabapentin

PUVA, psoralen + ultraviolet light; SPF, sun protection factor; UVA, ultraviolet light therapy.