How to Spot Leukemia Rashes, Bruises, and Infections

Leukemia is a type of blood cancer that causes the rapid growth of abnormal blood cells. Myeloid leukemia affects the early development of red blood cells, white blood cells, and platelets. Lymphocytic leukemia causes abnormal development of white blood cells.

The rapid production of abnormal blood cells leads to various symptoms, including those that affect the skin. Certain leukemia treatments, like chemotherapy, can also cause skin complications.

1. Easy Bruising and Bleeding Under the Skin

2. Leukemia Cutis

Leukemia cutis occurs when leukemia cells infiltrate the skin. It typically presents as firm papules, plaques, or nodules that may appear violet, red-brown, or flesh-colored, says Dr. Chaer. On darker skin tones it may appear dark purple, grayish, or hyperpigmented.

Brittany Dulmage, MD, a board-certified dermatologist who specializes in oncodermatology at The Ohio State University Wexner Medical Center in Columbus, notes that the rash typically appears as raised bumps that may appear red or purple in color on lighter skin tones.

Treatment focuses on managing the underlying leukemia rather than the skin alone, Chaer says.

3. Folliculitis

Folliculitis is a bacterial infection that presents as itchy, acne-like bumps, says Dr. Dulmage. On darker skin, she says, they appear “more hyperpigmented.”

4. Tinea (Ringworm)

People with leukemia are more susceptible to fungal infections like ringworm, due to their weakened immune systems.

5. Morbilliform Drug Eruption

Morbilliform reaction can be treated with steroids, oral steroids, or other immunosuppressive medications. Chaer notes he may treat drug reactions by reducing the dose or discontinuing the medication.

6. Vasculitis

7. Toxic Erythema of Chemotherapy (Chemo Rashes)

Chaer notes that reactions to chemotherapy “may include dry, irritated, or acne-like skin changes.” Dulmage adds that it “often appears as ‘sunburn-like’ skin changes that tend to happen in skin folds.”

Chaer also adds that erythema (skin redness) may appear “subtler or absent in darker skin tones, making inflammation or rash more difficult to detect without close inspection or palpation.”

Chemo rash may also cause pain, swelling, or blistering.

• High-potency topical corticosteroids
• Topical keratolytics
• Wound care
• Pain control

Chaer notes that “these reactions usually improve over time and may benefit from gentle skin-care routines and moisturizers.”

8. Sweet Syndrome Rash

Less commonly, a person may develop a condition called Sweet syndrome. Dulmage describes Sweet syndrome as “tender, inflamed skin lesions that are often accompanied by a fever.”

Chaer adds that Sweet syndrome “presents as painful, red, swollen papules or plaques, often accompanied by fever and a high neutrophil counts.”

He goes on to say that it may appear as “dark purple, grayish, or hyperpigmented rather than red” on darker skin tones.

“While skin rashes can occur in leukemia, the more common symptoms are due to a shortage of healthy blood cells. This happens because leukemia cells crowd out normal blood-forming cells in the bone marrow,” explains Chaer.

“As a result, patients with acute leukemia may have low levels of red blood cells, white blood cells, and/or platelets,” he says, “leading to a variety of symptoms, depending on which cell lines are affected.” Leukemia symptoms vary based on the affected blood cells.

• Fatigue and weakness
• Fever
• Unexplained weight loss
• Recurring nosebleeds
• Frequent infections
• Easy bruising or bleeding
• Swollen lymph nodes
• Bone pain
  

Chaer notes that there are several reasons you should see a doctor as soon as possible. He says you should “seek medical attention if a rash is new or rapidly spreading, especially if you have a history of leukemia. Prompt evaluation is also recommended if the rash is painful, itchy, or accompanied by fever or swelling, as these could indicate an infection or a condition such as Sweet syndrome.”

He also adds that “if a rash develops after starting a new medication, medical evaluation is important to rule out an allergic or drug-related reaction.”

“Anyone undergoing treatment for leukemia should check in with their oncology team whenever a new rash appears,” Dulmage says. “It is important not to wait, as medication-related rashes can worsen if the offending medication is continued.”

• Leukemia can cause several types of skin issues, including bruising, rashes, and infections.
• Leukemia can affect the skin directly or indirectly, such as from reactions to medications or chemotherapy.
• Treatments will vary depending on how leukemia is affecting the skin. It may include additional therapies or changes in current treatment plans.
• You should see a doctor if a new, painful, or itchy rash develops. If any skin reaction occurs after starting a new medication, you should also see your doctor.