Leukemia Rash Pictures and Symptoms

Leukemia is a type of cancer that starts in the bone marrow and causes the overproduction of abnormal blood cells. These cells interfere with normal blood clotting and place other stresses on the body, including the skin.

A leukemia rash commonly describes a skin rash that occurs during the early stage of the disease in which tiny blood vessels burst and cause little red, brown, or purple dots. It can also describe skin rashes that develop with advanced leukemia or as a result of leukemia treatment, causing bumps, nodules, blisters, and other abnormal skin changes.

Some of these skin symptoms include:

• Pale skin
• Easy bruising
• Petechia or purpura
• Skin infections
• Skin rashes
  

This article discusses the causes and symptoms of the different leukemia rashes and how each is managed or treated.

What Skin Symptoms Occur From Leukemia?

In early-stage leukemia, rashes happen because the disease interferes with the production of platelets (thrombocytes), a type of blood cell responsible for blood clotting. In someone with leukemia, these cells are misshapen and nonfunctional.

Leukemia also damages the walls of blood vessels, making them vulnerable to rupture. Without enough healthy platelets to form clots, blood can flow freely into the surrounding skin when weakened capillaries burst, producing spots under the skin.

Leukemia rashes can appear just about anywhere on the body. Some common locations are the chest, trunk, legs, feet, neck, face, hands, and arms.

These are some of the skin conditions that can occur with leukemia. Some are early signs of the disease, while others may appear in later stages or as a side effect of medication.

Petechiae and Purpura

Petechiae affects around 40% of people with leukemia and can sometimes be the very first sign of the disease. Petechiae are pinpoint spots that are painless and may be red, purple, or brownish, depending on your skin tone. They can resemble atopic dermatitis, a common skin rash.

Petechiae differs from similar skin conditions in that the spots do not blanch (whiten) when you press them. The spots typically lie flat against the skin and are no larger than 2 millimeters in size.

When the spot is between 2 millimeters and 1 centimeter, it is referred to as purpura. These lesions are typically raised but are also usually painless (although some can feel tender). Unlike petechiae, purpura rashes tend to be irregularly shaped.

Easy Bruising

Spots over 1 centimeter are called ecchymosis. The term is often used interchangeably with bruises. When leukemia is involved, the bleeding is not caused by trauma but by the absence of healthy platelets.

Ecchymosis, also known as "leukemia bruises," can appear for no apparent reason. It's often seen on unusual parts of the body (such as the back, chest, or face).

Some signs that bruising may be a symptom of early leukemia include:

• You can't remember how you got the bruise.
• The bruise occurs after a minor bump.
• You have many bruises and/or you experience frequent bruising.
• The bruise is somewhere unusual, such as on your hands.
• Your bruises take longer to go away than they should.
• You have bruising along with easy bleeding.
  

If you have leukemia and are experiencing easy bruising, you can manage your bruises at home by taking the following steps:

• Apply an ice pack as soon as you notice the bruise. Keep it on the area for 20 minutes at a time, up to a few times a day.
• After the first 48 hours, apply heat to the bruise up to a few times a day.
• If possible, keep the bruise raised above the level of your heart.
• If your bruise is painful, ask your healthcare provider which OTC pain medications are safe for you to take. You'll likely be told to avoid medications that think the blood, such as aspirin.

Once you begin to undergo treatment for leukemia, bruising, petechiae, and purpura will usually resolve. Other treatments can target the symptom directly, including corticosteroids (steroids) which reduce the swelling of blood vessels, and vitamin C supplements, which help strengthen blood vessels.

Leukemia Cutis

Leukemia cutis is a relatively rare skin condition that’s caused by leukemia itself. It is typically seen with advanced leukemia or a form of the disease called acute myeloid leukemia (AML). Only around 2% or 3% of people with leukemia get leukemia cutis.

Leukemia cutis results when abnormal white blood cells (called neoplastic leukocytes) make their way into the skin, causing lesions of various sizes and appearances. Some may be thick and scaly like psoriasis or eczema, while others may involve papules (bumps), nodules (larger lumps or masses), bullae (blisters), or ulcers (open sores).

Leukemia cutis is mainly treated by treating leukemia itself. Localized treatments like phototherapy, external beam radiation, and low-energy electron beam therapy may help ease skin symptoms.

Easy Bleeding

A person with leukemia may bleed more than usual. This is because blood doesn't clot as effectively in someone with low platelets. You may notice this while doing things that wouldn't normally cause bleeding, such as:

• Brushing your teeth
• Blowing your nose
• Eating hard foods

If you have periods, they may be heavier than usual.

Sweet's Syndrome

Sweet's syndrome is a rare skin condition that affects some people with leukemia, particularly those with AML. It is characterized by:

• Fever
• Sudden outbreak of tender red or bluish-red bumps or lesions
• Headaches
• Painful joints
• Conjunctivitis (pink eye)
• Blisters and ulcers
  

Skin changes with Sweet's syndrome are most likely to be seen on the arms, legs, trunk, face, or neck.

Sweet's syndrome can affect people with leukemia as well as those without. When leukemia is involved, it may occur on its own or as a reaction to granulocyte-colony stimulating factor (G-CSF) drugs like Neulasta (pegfilgrastim) that stimulate the production of white blood cells in people undergoing chemotherapy.

Sweet's syndrome is treated with corticosteroid drugs that help ease inflammation.

Mastocytosis

Mastocytosis happens when white blood cells called mast cells overaccumulate in tissues. It is associated with a type of leukemia called mast cell leukemia, but may also occur in people with AML.

A person with mastocytosis may develop a rash called urticaria pigmentosa, which causes brownish, raised patches of skin that sting or itch when touched. The rash may also hurt or itch in response to changes in temperature.

Other symptoms of mastocytosis can include:

• Skin redness and warmth
• Gastrointestinal symptoms like nausea, bloating, diarrhea, or pain
• Acid reflux
• Shortness of breath
• Lightheadedness
• Headache

There are few treatments available for mastocytosis. Depending on the severity, your healthcare provider may recommend medications such as:

• Cromolyn sodium
• Bisphosphonates
• Leukotriene-inhibitors
• Corticosteroids

For people with severe cases, targeted therapies, chemotherapy, and immunotherapy may also be options. 

Mouth Sores and Swollen Gums

People with leukemia often have chronic mouth sores and infections of the mouth. These can be early signs of the disease. Some of these symptoms include:

• Mouth ulcers
• Bleeding gums
• Swelling of the gums or cheeks
• Pale mucous membranes
• Petechiae in the mouth
• Difficulty moving the jaw

These symptoms can be managed with over-the-counter medications or medicated mouthwash. Your healthcare provider may also prescribe steroid medication.

Chloroma

Chloroma, also known as granulocytic sarcoma, is a rare type of cancer that occurs when leukemia cells form a tumorous mass. It can develop on the skin but also in the brain, bones, breasts, intestines, or lungs.

On the skin, chloromas appear as one or several shiny nodules that are firm to the touch and reddish to purplish in color. When cut open, the nodules sometimes have a blue-green interior. The size of the nodules can vary but those on the skin can get as large as a grape.

Chloromas affect up to 9% of people with AML. They commonly occur following remission or recurrence of leukemia, but can occasionally occur as an early symptom or later complication of the disease.

Chloromas can be managed with chemotherapy to treat the underlying leukemia.

Leukemia-Related Skin Symptoms

Besides causing a rash, leukemia may affect the skin in other ways. For example, in the early stages, you may notice that minor skin injuries bleed much more than usual. This is because blood doesn't clot as effectively in someone with low platelets. Other skin problems that may occur with leukemia include:

• Mouth sores or swelling and bleeding from the gums
• Frequent nosebleeds
• Pale skin caused by a reduction in the amount of oxygen in the blood
  

Summary

Skin rashes are common during every stage of leukemia and may even occur in response to certain drugs used to treat leukemia. These include petechiae, purpura, and ecchymosis (which often occurs during the early stages of the disease) or leukemia cutis, mastocytosis, and chloroma, which may occur in later stages of the disease or with certain forms of leukemia.

Sweet's syndrome is a rare skin condition that can develop on its own or as a reaction to drugs like Neulasta (pegfilgrastim).

Leukemia treatment can help resolve or improve leukemia rashes. Other treatments may help treat the rashes themselves, including corticosteroids and phototherapy.