Cutaneous manifestations of leukemia

Skin symptoms of leukemia are specific and non-specific. Specific changes caused by the growth in the skin pathological blood-forming tissue. In most cases, the skin proliferat consists of leukemia cells corresponding to one or another form of leukemia. Clinically specific skin changes occur uzelkove and knotted (granulomas) neoplasms (Fig. 1 and 2), ulcero-necrotic changes in the place of destruction leukemia proliferate, partial or universal redness of the skin.


Fig. 1 and 2. Specific skin changes with leukemia.

Non-specific, but related to leukaemia skin changes may be of different origin. Toxico-allergic lesions clinically manifested skin itching, urticaria, cystic acne, ulcero-necrotic changes. Skin changes may also be caused by insufficient blood (thrombocytopenia, anemia, mass destruction of blood cells), manifested by hemorrhages, pallor, yellowness of the skin. By reducing General and immunological resistance in patients with leukemia often infectious diseases of the skin is blotchy, fungal, viral (herpes zoster).
Sometimes when leukemia arise skin lesions associated with therapy (zitostaticescoe, hormonal, radiation). Clinically they are hyperpigmentation of the skin, hair loss, ugrevidnaya rashes, dermatitis, ulcers. Skin lesions leukemia can be common to all forms of leukemia, as well as specific forms of leukemia. Unequal and the frequency of occurrence of those or other skin changes at various phases and forms of leukemia.
The success of the treatment both specific and non-specific skin changes with leukemia depends on the effectiveness of treatment the main process. Usually with the improvement of the main clinical and hematological parameters and improves skin condition. However, this does not preclude the need symptomatic, including local, treatment of skin. Good effect, as a rule, have a corticosteroid ointment (prednisolone, oksikort, lookeren sinalar and others).

The frequency of skin lesions, according to various authors, varies from 1%to 20%. There are specific and considerably more frequent non-specific lesions, called Audrey (C. Audry) lakeside. Last clinically diverse and can manifest itself in the form of various dermatoses, often itchy (type prurigo, eczema, dermatitis herpetiformis, simple bubble and shingles, and so on); there are eritrodermii.
The most frequent symptom of skin lesions leukemia - intense itching.
Specific skin lesions leukaemia (printing. Fig. 1 and 2) is clinically manifested mainly sharply defined round or oval painless subcutaneous nodes or tumor-like formations of different size. At first they covered the unchanged skin, and then get a reddish, brown or slate-grey, usually with a bluish tinge. Pitting and development of scar rarely see. Sometimes infiltrated plaques with papillomatosis growths. The most frequent localization - the person, sometimes to create a similarity with facies leonina with leprosy. Much less common are the specific leukemic the eritrodermii.
Specific skin lesions with leukemia in the vast majority are one of the manifestations of the underlying disease (leukemia). Described isolated observations primary autochthonous skin origin leukemic infiltration system without defeats.
Both specific and non-specific skin lesions observed at different for all forms of leukemia. The correspondence between the type of Leningrad and the nature of the lesions is not observed. Apparently, most often affected skin with chronic leukemia. There are three forms of skin lesions with L.: 1) limited lymphedemas skin (lymphadenosis cutis circumscripta), 2) the generalized destruction (lymphadenosis cutis universalis), 3) malignant lymphodemia sarcoma (lymphodermia perniciosa Kaposi).
Cutaneous manifestations of myelogenous leukemia has been studied less, they are in General similar to those in leukemia; specific manifestation are tumors (leukaemia cutis myeloides), developing, as a rule, in the terminal phase of illness (unlike limfoleikozom where skin lesions, particularly skin itch, are often the first clinical symptom of the disease). For acute myeloid leukemia frequent purpura, gemorragii.
Histologically specific leukemic infiltration are characterized by a collection of cells corresponding series: the lymphoma - leukemia, myeloid (giving positive oxidase) - when mieloze, etc. For leukemia characterized by the so-called phenomenon of Indian phalanx: in the dermis and even in subcutaneous adipose tissue single rows of cells of the lymphoid series spread from the primary tumor mass in the gaps between the bundles of collagen fibers [lever (W. F. Lever)]. S. K. Rosenthal believes that infiltrates develop mainly of connective tissue surrounding the sebaceous and sweat glands. Lakeside, as a rule, do not contain leukemic infiltration, however, a clear parallel between the clinical manifestations and morphological changes, which once more emphasizes the arbitrariness of the clinical division of skin lesions with leukemia on specific and non-specific. Apparently, there are transitional forms.
Treatment of dermal manifestations of leukemia - General; testimony (itching) - symptomatic.