Leukemia Rashes, Infections, and Bruises

Leukemia is a type of blood cancer that affects the blood cells and bone marrow, a tissue inside bones where blood cells and platelets are made.

When someone has this disease, the cells normally produced in the bone marrow, such as white blood cells, which fight infection; red blood cells, which carry oxygen throughout the body; and platelets, which help form blood clots, will be crowded out by abnormal leukemia cells. 

In addition to symptoms like nausea, fever, fatigue, weight loss, and infections, leukemia can also produce a variety of skin problems such as bruising, skin rashes, and bleeding.

“We see a few major categories of skin findings in patients with leukemia,” says Amy Forrestel, MD, director of dermatology at the University of Pennsylvania. “The most common skin condition is bleeding into the skin.”

In other cases, some have no skin conditions, Dr. Forrestel says. “It depends on the type of leukemia. The more aggressive ones that require stem cell therapy or chemotherapy almost always have skin findings.”

1. Bleeding Under the Skin

Leukemia affects the body’s production of platelets, which normally form blood clots to stop bleeding. That can set the stage for bruising. “When platelets become low, patients often bleed into the skin spontaneously or with minimal trauma,” Forrestel says.

Capillaries burst underneath the skin, and if there aren’t enough platelets to block damaged capillaries, blood leaks into the skin, Forrestel says. In addition to petechiae (red dots on the skin), this can appear as purpura (larger red or purple areas), or ecchymoses (bruises), she says.

According to Forrestel, these spots usually take weeks to go away, but gentle skin care and avoiding trauma when possible can also help prevent the condition.

2. Leukemia Cutis

During the progression of leukemia, white blood cells (neoplastic leukocytes) found in bone marrow may begin to filter into the layers of the skin, resulting in skin lesions.

“It looks like red-brown to purple firm bumps or nodules and represents the leukemia cells depositing in the skin,” Forrestel says. “Treatment for leukemia cutis is simply treating the specific type of leukemia. There’s nothing separately we do to treat the lesions.”

3. Folliculitis

Because leukemia inhibits the development of mature white blood cells, which fight infection, the body is much more susceptible to skin infections. One common type of infection patients may develop is folliculitis, an inflammation of the hair follicles. Folliculitis may occur as a result of a bacterial or fungal infection.

Once the infection has been diagnosed, healthcare providers prescribe the appropriate antibacterial or antifungal therapy, which may include cream or oral medication, according to Forrestel.

4. Tinea (Ringworm)

This is a fungal infection that may appear as white, pink, red, or brown patches on the skin. It’s most commonly seen on the neck, chest, back, and arms.

5. Morbilliform Drug Eruption

This is a common allergic reaction to medication that results in a skin rash that resembles measles. It usually forms 7 to 10 days after the drug is first taken.

6. Vasculitis

Vasculitis occurs when the body’s blood vessels and the area around the vessels are inflamed. It appears as purple spots, petechiae (tiny purple, brown, or red spots), or purple, netlike lesions that develop on the skin. Treatment options may include cyclosporine or Prograf (tacrolimus).

7. Chemo Rashes

A chemotherapy rash resembles acne and can show up on the face, scalp, neck, chest, and back, resulting in tenderness, irritation, burning, and stinging. Treatment options may include retinoids, benzoyl peroxide, hydrocortisone, doxycycline, and antihistamines.

8. Sweet’s Syndrome Rash

Because the body’s immune system is compromised, someone with leukemia may develop a rare skin condition called Sweet’s syndrome. “In Sweet’s syndrome, a patient can develop pink bumps or plaques, that can look like insect bites due to inflammatory cells (neutrophils) entering the skin,” Forrestel says. In addition to the rash, symptoms may include fever or chills. The most common treatment for the rash includes a corticosteroid, such as prednisone.