Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2023;13(3):e2023189 1 Successful Treatment of Morpheaform Graft-Versus-Host Disease: A Dermoscopic Follow-up of 1 Year Rohit Kothari1, Shekhar Neema2, Anuj Bhatnagar1, Karthi Kishore1, Jeenu Varghese3 1 Dermatology, Command Hospital Air Force, Bengaluru, India 2 Dermatology, Armed Forces Medical College, Pune, India 3 Pathology, Command Hospital Air Force, Bengaluru, India Citation: Kothari R, Neema S, Bhatnagar A, Kishore K, Varghese J. Successful Treatment of Morpheaform Graft-Versus-Host Disease: A Dermoscopic Follow-up of 1 Year. Dermatol Pract Concept. 2023;13(3):e2023189. DOI: https://doi.org/10.5826/dpc.1303a189 Accepted: March 16, 2023; Published: July 2023 Copyright: ©2023 Kothari et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Rohit Kothari, Assistant Professor, Dermatology, Command Hospital Air Force, Bengaluru, Cambridge Road, Agram post, India-560007. Telephone: (+91) 9660650747 E-mail: rohitkothari3422@gmail.com Case Presentation A 40-year-old male underwent hematopoietic stem cell transplant (HSCT) for acute myeloid leukemia. He presented with itching, erythema, and induration over the anterome- dial thigh (Figure 1A), one-year post-HSCT. Dermoscopy re- vealed background erythema, prominent pigment network, perifollicular blue-gray and whitish structureless areas, scal- ing, and reduced hair-follicles (Figure 1B). Histopathology showed orthokeratosis, mild acanthosis, basal cell vacuolar degeneration, and mild lichenoid lymphocytic infiltrate in the interface. Superficial and deep dermis showed parallelly arranged thickened collagen bundles and mild lymphocytic perivascular inflammation with melanophages (Supplemen- tary Figure). The background erythema, prominent pigment network, and perifollicular blue-grey and whitish structure- less areas on dermoscopy corresponds to lymphocytic in- flammation, melanophages, lichenoid infiltrate and collagen bundles, respectively. He was diagnosed as localized mor- pheaform graft-versus-host disease (GVHD). He was managed with super-potent topical corticoste- roids (TCS) twice daily for 6 months and once-daily there- after following favorable response. Follow-up at 1-year revealed completely regressed lesion without any indura- tion or erythema (Figure 1C). Repeat skin biopsy did not show any features of GVHD. Dermoscopy revealed reso- lution of erythema and scaling signifying settled inflam- mation, telangiectasias due to potent TCS use, peppering, and prominent white structureless areas due to fibrosis (Figure 1D). Teaching Point The dermoscopic features of localized morpheaform GVHD are not well established. Kaminska et al described granu- larity, rhomboidal pigment arrangement, mild scaling, and white patchy areas; however, no follow-up dermoscopy was performed [1]. We found that follow-up dermoscopy may give an important clue regarding the treatment response. The disappearance of erythema and scaling, prominent white 2 Image Letter | Dermatol Pract Concept. 2023;13(3):e2023189 structureless areas and appearance of peppering signified ad- equate treatment response in our patient. References 1. Kaminska-Winciorek G, Zalaudek I, Mendrek W, Jaworska M, Gajda M, Hołowiecki J, Szymszal J, Giebel S. Dermoscopy of Cutaneous Graft-Versus-Host-Disease in Patients After Alloge- neic Hematopoietic Stem Cell Transplantation. Dermatol Ther (Heidelb). 2020;10(5):1043-1061. DOI: 10.1007/s13555-020- 00423-6. PMID: 32676797. PMCID: PMC7477036. Figure 1. (A) Localized morpheaform graft-versus-host disease showing erythema and induration over anteromedial thigh. (B) Dermoscopy (Illuco IDS-1100, polarized 10x) showing background erythema, prominent pigment network, perifollicular blue-gray (black circles) and whitish structureless areas (red circles), scaling, and reduced hair-follicles. (C) Follow-up at 1-year showing completely regressed lesion with post-inflammatory hyperpigmentation. (D) Der- moscopy (Illuco IDS-1100, polarized 10x) showing telangiectasias (arrows), peppering (circle), and white structureless areas (stars).