Parafollicular hair bulge is an early target of graft-vs-host disease (GVHD) and its involvement can cause hair disturbances as a manifestation of GVDH. These hair disturbances are insufficient alone to establish the diagnosis but with other features could signalized chronic GVHD activity. We report a patient with chronic GVHD after an allogeneic stem-cell transplantation who developed an extensive hair loss 3 years after the transplant as a manifestation of chronic GVHD activity. Case report: 23-years-old female with chronic skin GVHD, keratosis pilariselike, 3 years after an allogeneic peripheral stem-cell transplantation, secondary an acute lymphoid leukemia developed acute hair loss and aggravation of skin lesions during withdrawal of immune suppression. On exam, diffuse hair loss, with short and thinning hair, the pull test was positive with telogen, poikiloderma, dyspigmentation confetti-like on sun-exposed areas, keratosis pilaris like lesions at upper limbs. A scalp biopsy showed: basal-cell vacuolization of the follicular epithelium with lymphocytic exocytosis, the skin biopsy from right arm showed apoptotic keratinocytes with hydropic degeneration of the basal layer. Clobetasol propionate topical solution 0.05% was prescribe at night and minoxidil 5% during the morning. After a month, the hair has grown and the pull test was negative, five months later, she was recovered. Discussion: Scalp and body hair can be affected in GVHD. Distinctive features of chronic GVHD include new scarring and nonscarring scalp alopecia and loss of body hair. Other characteristics seen with chronic GVHD include premature graying, thinning, or brittleness hair, lichenoid follicular rash, comedonal lesions. Other causes of hair loss after allogenic transplant should be excluded including persistent alopecia after recovery from chemotherapy and radiotherapy, medications, metabolic issues, endocrine dysfunction, scalp infection, telogen and androgen effluvium, androgenetic alopecia and alopecia areata. All hair disturbances in chronic GVHD are insufficient alone to establish a diagnosis of chronic GVHD. Conclusion: We brought this case to highlight to signalized that the new onset of nonscarring alopecia after transplantation could signalized chronic GVHD activity and as GVHD and its various presentations will be more common at clinical practice the dermatologists could play a major role in diagnosis and treatment. Commercial support: None identified.

The roles of eotaxin, RANTES, and MCP-3 expression in eosinophil recruitment to the site of parasite killing that occurs following ivermectin treatment of onchocerciasis were assessed in the skin of 13 Onchocerca volvulus-infected subjects and two noninfected controls before and after ivermectin treatment. Adverse reactions in infected subjects were associated with the appearance of eosinophils in the dermis as part of a perivascular inflammatory infiltrate. Although no expression of RANTES and eotaxin was seen in dermal vascular endothelial cells in biopsies taken before treatment (nor at any time in the skin of uninfected controls), endothelial expression of both eotaxin and RANTES was noted by 24 h following treatment. While RANTES expression was transient, eotaxin expression increased in parallel with increasing eosinophil recruitment up to 60 h posttreatment. These observations indicate that endothelial expression of eotaxin and RANTES may have an important role in eosinophil recruitment into the skin during helminth-killing reactions.