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Leukemides of the skin (skin leukemia)

 
, medical expert
Last reviewed: 04.07.2025
 
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Skin leukemias (synonyms: skin leukemia, hemodermia) are symptoms of leukemia and appear in its terminal stage. However, sometimes skin signs are the initial symptoms of leukemia, when other signs (changes in blood, lymph nodes and bone marrow) are still absent.

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Causes and pathogenesis of skin leukemids

To this day, the nature of leukemia remains unknown. According to most scientists, leukemia is based on a tumor process in hematopoietic tissue, controlled by a specific gene.

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Symptoms of cutaneous leukemids

Skin rashes in leukemia are divided into specific and non-specific. Non-specific ones lack characteristic morphological features and can be caused by concomitant processes and complications (anemia, thrombocytopepia, sepsis). In the latter case, sometimes long before the appearance of clinical signs of damage to the hematopoietic system, skin itching, pruriginous, bullous, erythematosquamous rashes appear, resembling pemphigus, erythema multiforme, eczema, lupus erythematosus, etc. Skin rashes intensify during the period of exacerbation of the underlying disease. In the terminal stage of leukemia, multiple hemorrhages and septic necrosis of the skin are often noted.

Specific changes in skin leukemia are varied and often occur in the form of papular, nodular and tumor-like formations and erythroderma.

The most common are numerous papular, less common - spotted-papular elements, which are more typical for myeloblastic leukemia. Nodules of various sizes (from a millet grain to a pea) have rounded outlines, a hemispherical or flat shape, a dense, less common - soft consistency, a bluish-red color, often with a yellowish-brown tint. The surface of the papules is smooth, sometimes it can be covered with telangiectasias, scales or leaf-shaped crusts. The elements are often located symmetrically and can be found on any areas, including the mucous membranes of the mouth. As a rule, they appear suddenly and are located symmetrically on different areas of the skin. Subjective sensations with the papular variant are usually not noted, sometimes patients complain of itching of the skin.

Nodular leukimids have a bluish-pink or brownish-brown color, a smooth surface, on which hemorrhagic rashes, telangiectasias, layered crusts and milium-like papules are sometimes determined, which arise as a result of blockage of dilated hair follicles. They progress slowly. Subjective sensations include pain when pressing, there is no itching of the skin. Spontaneous regression of individual nodules is possible.

In acute leukemia, the color of the elements becomes deep red, blisters, ulcers, petechial rash are formed, and the mucous membranes are affected. Tumor-like leukemids arise as a result of the fusion of several separate nodules, penetrate deeply into the hypodermis, are large in size, and have a dense consistency (sometimes woody). A combination of several specific rashes with non-specific skin lesions is often noted.

Sometimes specific erythroderma may develop, which is often found in chronic lymphocytic leukemia, monoblastic leukemia, and less often in other types of leukemia. Such erythroderma is characterized by intense itching, and it is clinically difficult to distinguish it from erythroderma of other origins.

In skin leukemids, diffuse infiltrations and primary ulcers may occur. As a result of skin thickening and the formation of deep and superficial grooves on its surface, diffuse infiltrations occur that occupy large areas of the skin.

Primary ulcers in hemodermia of round or oval shape reach significant sizes (5-10 cm and more in diameter), have a shiny juicy bottom of a deep red color. The bottom of the ulcer is often covered in places with granulations, purulent-necrotic plaque and bloody crusts. Ulcers have uneven, undermined, infiltrated edges.

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