This is the picture of chronic graft versus host disease. After the acute stage of generalised erythroderma, lichenoid papules mat evolve with oral ulceration and some nail dystrophy. Later the skin becomes harder and bound down and looks and feels like scleroderma with even the salt and pepper pigmentation changes. Sometimes acute GVH disease damages the epidermis similar to toxic epidermal necrolysis with skin blistering and peeling. In less severe cases the palms and soles may blister and peel. The gut and lungs are also commonly involved in the acute variant.
The condition can be managed with immunosuppressive drugs or phototherapy.