Cutaneous chronic graft-versus-host disease in skin of color most often presents as lichen planus and dyspigmentation

Summary: Abstract Body: Chronic graft-versus-host disease (cGVHD) is a multisystem complication of allogeneic hematopoietic cell transplant (HCT) leading to significant morbidity and mortality. While 80% of cGVHD patients exhibit cutaneous involvement, less than 33% of HCT recipients self-identify as non-white and cutaneous cGVHD in skin of color (SOC) is underexplored. We characterized the clinical features of cutaneous cGVHD in SOC according to 2014 NIH Consensus Criteria. This retrospective study analyzed SOC allogeneic HCT patients (Black/African American, Asian, Hispanic, and/or American Indian/Alaskan Native [AI/AN]) treated at the University of Pennsylvania between 2014-2024. Of 138 SOC patients receiving allogeneic HCT, 25 (18%) had cutaneous cGVHD (11 (44%) Black/African American, 8 (32%) Asian, 3 (12%) Hispanic, 2 (8%) AI/AN, and 1 (4%) Asian-Hispanic). The mean (SD) age at HCT was 46.2 (11.8) years, with cutaneous cGVHD developing mean (SD) 313.0 (169.7) days post-transplant. Biopsy confirmed cutaneous cGVHD in 10 (40%) cases. At diagnosis, 19 (76%) had non-sclerotic cGVHD, while sclerotic (4 [16%]) and combined (2 [8%]) presentations were less common. 16 (64%) patients were classified as having dyspigmentation at the initial cGVHD visit. 23 distinct clinical features were identified at initial or subsequent visits including 22 (88%) hyperpigmentation, 17 (68%) lichen planus, 16 (64%) pruritus, 12 (48%) erythema, 9 (36%) hypopigmentation, and 8 (32%) sclerosis. Like non-SOC populations, lichen planus was the most common diagnostic clinical feature; however, dyspigmentation was the most common overall feature of cutaneous cGVHD in SOC. These findings underscore the importance of differentiating post-inflammatory pigmentary changes from active disease for accurate diagnosis, grading, and management of cutaneous cGVHD in SOC populations. Iain Noel Encarnacion^{1, 2}, Noelle Desir^{3, 2}, Emily Baumrin² 1. Macon & Joan Brock Virginia Health Sciences at Old Dominion University Eastern Virginia Medical School, Norfolk, VA, United States. 2. University of Pennsylvania Department of Dermatology, Philadelphia, PA, United States. 3. Weill Cornell Medicine, New York, NY, United States. Minoritized Populations and Health Disparities Research