Skin and blood diseases

Numerous observations have established that in diseases of hematopoiesis, changes on the skin relatively often occur, which are called hemoderma. They are very variable, and therefore create diagnostic difficulties, although with correct interpretation they can serve as markers of blood diseases. The final diagnosis is established by histological examination of the structure of the affected areas of the skin. This method also allows you to decide whether the rash is specific or nonspecific. Let's consider the clinical aspects of hemoderma.

Diagnosis of hemoderma becomes important, since skin manifestations of leukemia may precede other objective signs of the underlying disease.

Specific hemoderma manifests itself mainly in the form of papules, tubercles, nodes, limited infiltrates, and plaques. In some cases, single and multiple nodes resembling tumors are observed. Selective localization of tumor-like formations is the face; they are often located symmetrically. These nodes can have different colors, but most often have a purple tint. Their consistency is dense or soft, these formations are painless, grow slowly and do not always disintegrate to form an ulcer. More often, such nodes develop in undifferentiated forms of leukemia, myeloid leukemia, and rarely in lymphocytic leukemia. Histological examination of such elements of the rash acquires exceptional importance, since elements of an isomorphic tissue reaction of the hematopoietic organs can be detected in the infiltrate.

An intermediate position between specific and nonspecific skin lesions in leukemia is occupied by erythroderma, which often begins as a nonspecific rash and ends with the formation of a specific infiltrate.

Nonspecific skin lesions in leukemia, from the point of view of clinical and morphological characteristics, are no different from ordinary dermatoses. They often occur under the guise of eczema, dermatitis, atypical erythema multiforme, generalized herpes zoster, psoriasis, lichen planus, lupus erythematosus, etc. With lymphocytic leukemia, a characteristic nonspecific skin manifestation is an itchy rash with the formation of papules, and then lichenification. Itching is widespread and can be constant or intermittent. Along with itching, various rashes often appear on the skin in the form of urticarial elements, papules, vesicles, bullous elements, reminiscent of eczema or dermatitis herpetiformis. In patients with lymphocytic leukemia, the development of skin itching may precede the appearance of clinical signs of leukemia.

In cases of hematological diseases, the skin often becomes dry, peeling and a change in normal color. In cases of lymphocytic leukemia and the development of erythroderma, the skin is red, swollen, with significant peeling. Sometimes psoriasis-like plaques are observed on the extensor surfaces of the extremities. A frequent companion to leukemia is hemorrhagic syndrome, in which hemorrhages in the skin, mucous membranes, nasal, intestinal, uterine bleeding and ulcerative-necrotic lesions of the mucous membranes of the mouth and gastrointestinal tract are observed. Especially often in cases of acute leukemia, hyperplastic and necrotic changes in the gums are observed, which become hyperemic, swollen, and painful. Sometimes hypertrophic gingivitis can be a diagnostic sign of acute leukemia.

The range of hemorrhages in the skin is from petechiae (multiple hemorrhages in the skin and mucous membranes that do not protrude above the surface of the skin and are not detected by palpation) to diffuse hemorrhages of various sizes up to the development of deep hematomas. The symptom of a tourniquet (the appearance of hemorrhages on the skin as a result of its compression by a tourniquet or tonometer cuff) in such cases is sharply positive. The color of the lesions, depending on the time of their occurrence, ranges from red to purple, brown, brown or dirty gray. At the sites of hemorrhages, necrotic decay can be observed with the formation of ulcers with undermined, flaccid, soft edges and an uneven bottom, covered with purulent-bloody discharge that bleeds easily. Such changes often occur at sites of trauma.

In patients with acute myeloid leukemia, the rash can be focal or disseminated in nature and consists of erythemal, papular, urticarial, vesicular, bullous elements. Possible grouping of rash elements. Children may develop nodules of dense consistency of various colors, which become necrotic within a week. A papular rash is not accompanied by subjective sensations; sometimes the papules may be painful when pressed. Erythroderma develops very rarely. Patients with acute myeloid leukemia during treatment with cytostatics often develop infectious diseases that lead to death.

In the initial stage of acute monoblastic leukemia, hemorrhagic syndrome also often develops, leukemic infiltration of the mucous membranes, which ends in disintegration with the formation of ulcers on the gums, tongue, tonsils, pharynx and is accompanied by an increase in regional lymph nodes, which become painful on palpation. In patients with this pathology, a skin rash is often the first and only symptom for a long time. In addition, a nonspecific rash resembling urticaria, erythema multiforme, which has the appearance of small roseola, vesicles with the formation of eczema foci, accompanied by weeping, may be observed. A specific rash in such patients more often appears with the development of the main symptoms of the disease and has the form of vesiculopapular elements that appear suddenly, are located symmetrically on different parts of the body and limbs, and necrotic decay of individual elements is possible. Some patients develop nodular elements of a dense consistency, red in color with a bluish tint, which can also disintegrate to form crater-like ulcers.

In cases of acute lymphocytic leukemia, frequent symptoms are also hemorrhagic syndrome, tonsillitis with enlarged cervical lymph nodes, progressive anemia and the rapid development of acute stomatitis with necrotic-ulcerative lesions of the mucous membrane. Hemorrhagic syndrome in such patients is characterized by extensive hemorrhages in the skin and mucous membranes, nasal and intestinal profuse bleeding. A nonspecific rash occurs in the form of papules, sometimes reminiscent of psoriasis, without subjective sensations.

With Cooperman's symptom, an expressive color border is visible at the site of the transition of the hard palate to the soft palate.

With the “rabbit eyes” symptom, conjunctival hyperemia occurs, the vascular network of which is dilated and filled with blood.

In patients with pernicious anemia, the skin and mucous membranes are pale, and in cases of very severe anemia, the skin and conjunctiva have a lemon-yellow tint. The surface of the tongue is often smooth and atrophic, but is sometimes red and inflamed. Paresthesia of the fingers and toes is observed.

In iron deficiency anemia, relatively common changes are angular stomatitis, glossitis, brittle fingernails, and koilonychia occurs less frequently.

Primary idiopathic aplastic anemia may be accompanied by hemorrhages in the skin and mucous membranes, necrosis in the oral cavity, mouth ulcers, and the development of fungal infections, which indicates the presence of neutropenia.

Acute hemolytic anemia is accompanied by the development of jaundice; in severe cases, hemorrhagic spots may appear on the skin and mucous membranes.

Patients with multiple myeloma have pale skin with an earthy tint. It is possible to develop nodules, plaques, and tumors, which can sometimes disintegrate to form ulcers.

So, we tried to determine the clinical aspects of possible skin changes due to blood diseases. Sometimes they precede the development of the main symptoms of the disease, which can be a valuable diagnostic sign.

Read the full version of the article in Cosmetologist No. 6, 2016