What Leukemia Does to Your Skin

Bruising is a well-known symptom of leukemia, a blood cancer diagnosed in about 60,000 Americans every year. But other skin symptoms, such as rashes and spots, also can be signs of leukemia. Some leukemia skin lesions are caused by the cancer; others occur due to leukemia treatment reactions or infections.

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Contact your doctor or care team for any new or concerning skin symptoms, especially if you have leukemia. Here’s a description of leukemia rashes, red spots, and other skin conditions that may occur in someone with leukemia.

One of the major skin disorders caused by leukemia is leukemia cutis ("cutis" means skin). Leukemia causes white blood cells, or leukocytes, to grow out of control and travel from your blood or bone marrow into your skin. As a result, you may see various skin eruptions, which can include:

• Bumpy growths, such as small papules or nodules (similar to warts or cysts), that feel firm or rubbery to the touch
  
• Plaques, which are larger, raised patches of skin that may be reddish and rough 
  
• Areas of skin discoloration, which range from red to brown, yellow, blue, gray or violet 
  
• Ulcers (open sores)
  
• Blisters, which can range in size and contain clear fluid or pus
  

Leukemia cutis rashes and lesions can appear on your face, trunk, arms or legs. Sometimes, they are the first symptom of leukemia (aleukemic cutis), though this only occurs in 2 to 3% of people who develop leukemia. More often, rashes and lesions begin during or after other leukemia symptoms.

About 5 to 10% of people with leukemia experience leukemia cutis, though the percentage is higher with some types of leukemia. Leukemia cutis is most common with acute myeloid leukemia (AML), affecting about 13% of people (though this can rise to 50% with some AML subtypes) and chronic lymphocytic leukemia (about 8%).

About 25 to 30% of children born with leukemia develop leukemia cutis. It can sometimes cause "blueberry muffin syndrome" in infants, resulting in blue or purplish spots or lesions on their bodies.

When someone with AML develops leukemia cutis, it may indicate a more serious prognosis.

Generally, there is not a separate treatment for leukemia cutis, apart from aggressively treating the underlying leukemia. Some people will see their skin lesions go into remission following chemotherapy.

A variety of other conditions can cause spots, lesions, growths, ulcerations or other symptoms in people with leukemia. Some of these skin conditions include:

• Petechiae. Petechiae are common in leukemia. These appear as little red or dark spots, dots, or tiny bruises just below the surface of the skin. They are due to small blood vessels called capillaries breaking down and leaking into the skin. You may find these spots in areas where blood collects, such as the feet, legs, arms or hands. 
  
• Blastic plasmacytoid dendritic neoplasm (BPDCN). Deep purple skin lesions are one of the chief symptoms of this rare type of acute leukemia, which people sometimes confuse with leukemia cutis. It is most common in those over 60 and affects four times as many males as females.
  
• Erythema nodosum. This condition can be an early sign of leukemia or lymphoma. It causes painful lumps or nodules that start below the surface of the skin, often on the legs. The color of the lumps varies by skin tone. 
  
• Paraneoplastic pemphigus. This rare, potentially life-threatening condition can affect not just the skin (with blisters and eczema) but also the mucosal tissues, such as the lining of the mouth and throat. About 7 to 18% of people with this condition have chronic lymphocytic leukemia. 
  
• Sweet or Sweet's syndrome (febrile neutrophilic dermatosis). Sweet syndrome has many causes, including leukemia. It may come on suddenly, with discolored bumps or scaly patches, along with fever and muscle or joint aches. If it persists, it is usually treatable with corticosteroids.
  
• Pyoderma gangrenosum. This rare skin disorder causes painful skin ulcers that can become necrotic (meaning skin tissues die). It is associated with myelocytic and hairy cell leukemia. One variant, atypical or bullous pyoderma gangrenosum, occurs with AML.
  

Most leukemia skin problems occur from reactions to medications or as a result of infections that overcome your weakened immune system.

Allergies to medications or treatment side effects that involve the skin are relatively common among people with leukemia. In general, treatment reactions range from mild skin outbreaks to full-body (systemic) reactions requiring treatment in a hospital. If you have leukemia, contact your care team for changes in your skin.

Bacterial, fungal or viral infections can trigger skin problems as well. Many of these organisms do not cause problems in people without leukemia and with a functioning immune system. But leukemia causes significant changes in the immune system, so they can grow unchecked. A few examples of these infections are:

• Folliculitis: Folliculitis is an infection of the hair follicles, often caused by commensal, or protective bacteria that ordinarily cause no problems. Folliculitis symptoms include itchy, white-headed pimples or small blisters on your scalp, face, neck, shoulders and other areas of your body. Warm compresses may help, or you may need oral or topical medications to clear the infection and reduce inflammation.
  
• Candida: Candida is a fungus that normally lives on your skin and is kept in check by a healthy immune system. Candida infection of the skin (cutaneous candidiasis) appears as a rash and can break out anywhere on the body, though it favors warm crevices, such as your armpits. Treatment options include antifungal skin creams, ointments or powders.
  
• Herpes zoster (shingles) or herpes simplex: These preexisting viral infections can flare up when your immune system is compromised. Your doctor may prescribe antiviral medicine or other treatments to help combat the pain and itching these infections can cause. 
  

It's important to stay on top of any new skin lesions, lumps or rashes. Your healthcare team can perform a thorough skin check and run tests and prescribe treatment if necessary.