Rashes - An Ubiquitous Finding in Leukemia

Introduction

Leukemia is a blood cancer that usually affects the bone marrow's white blood cells. Blood cells are produced in the bone marrow. Bore marrow is the spongy cells present inside the bones. Abnormal production of white blood cells causes leukemia. Leukemia is classified into acute, sudden onset, and gradually appearing chronic. Based on the affected type of white blood cells, leukemia is also classified into myeloid leukemia and lymphoid leukemia. Lymphoblasts and myeloid cells are the major types of white blood cells. The incidence of leukemia has no gender preference and occurs in all races.

What Is Leukemia?

Leukemia is a blood cancer affecting white blood cells or WBC. Leukemia is classified into four major types: acute myeloid leukemia or AML, chronic myeloid leukemia or CML, acute lymphoblastic leukemia or ALL, and chronic myeloblastic leukemia or CML. The significant symptoms of leukemias include increased bruising, skin rashes, and bleeding. The symptoms of leukemia are idiopathic, and some contributing factors will increase the risk of leukemia. The primary diagnosis of leukemia is blood tests. An abnormal blood count indicates the severity of leukemia, and the survival rate for leukemia is minimal. Acute myeloid leukemia, or AML, is an aggressive cancer type of leukemia.

The leukemia classifications are given below.

• Acute myeloid leukemia or AML.

• Chronic myeloid leukemia or CML.

• Acute lymphoblastic leukemia or ALL.

• Chronic lymphoblastic leukemia or CLL.

What Are the Symptoms of Leukemia?

According to the type of leukemia, the symptoms of leukemia will vary. The acute form of leukemia shows acute symptoms in the early stage, whereas, in the case of chronic leukemia, symptoms are absent in the beginning stage of cancer. Nevertheless, some signs of leukemia are ubiquitous.

The skin symptoms of leukemia are described below.

• Bruising and immediate bleeding.

• Mouth sores.

• Gingivitis.

• Leukemia cuts which include papules, small raised bumps on the skin, and skin lumps called nodules, plaques, blisters, and ulcers, are seen in the face, upper extremities, lower extremities, and trunk.

• Changes in skin color, especially pale, bluish and gray skin in the mucous membrane of the mouth, nose, and eyes.

• Skin rashes in acute myeloid leukemia or AML.

• Skin infections.

• Decreased host immune response.

• Petechiae are the tiny red pinpoint spots observed in feet, legs, arms, and hands.

• Symptoms of anemia include fatigue, tiredness, lightheadedness, and shortness of breath.

• Ringworm and other infections include candida and fungal infections.

• Folliculitis is the inflammation of the hair follicles. Pustules and papules are seen on the scalp, neck, face, and elbows.

• Allergic reactions to drugs.

• Chemotherapy and radiation therapy treatments also cause a skin rash.

• Systemic symptoms include excessive sweating, fatigue, weight loss, pain and tenderness in the bone, lymphadenopathy called enlarged lymph nodes, splenomegaly called enlargement of the spleen, and hepatomegaly called enlargement of the liver.

• Fever and chills.

• Cancer cells in the central nervous system cause headaches, nausea, vomiting, confusion, seizures, and loss of muscle control.

• Leukemia also affects internal organs, including the lungs, gastrointestinal tract, heart, kidneys, and testicles.

What Are the Causes of Leukemia?

The exact cause of leukemia is unknown. But it is found that some contributing factors will increase the risk of cancer.

Some of the risk factors of leukemia are described below.

• People with a history of chemotherapy.

• Increased exposure to radiation.

• Genetic disorders like down syndrome.

• Associated hematological disorders.

• Excessive cigarette smoking, the benzene chemical component, will increase cancer risk.

• Familial history.

How to Diagnose Leukemia?

Diagnosis of leukemia includes a physical examination, blood examination, histopathological findings, and imaging tests. A confirmed diagnosis is made with bone marrow aspiration cytology and biopsy. Staging is done after the diagnosis. Several tests determine the progression of leukemia.

The various diagnostic tools for the diagnosis of leukemia are mentioned below.

• History of the patient.

• Physical examination.

• Blood tests.

• Complete blood count or CBC to evaluate the number of red blood cells or RBC, white blood cells, WBC, and platelets.

• Tissue biopsy for examining the cancer involvement in lymph nodes and bone marrow.

• Biopsies of the liver and spleen in splenomegaly and hepatomegaly rule out cancer cells' metastasis in internal organs.

• Other tests include liver function tests or LFT.

• Lumbar puncture to examine the spread of cancer cells in the central nervous system

• Imaging tests include X-rays, computed tomography or CT scans, and ultrasound therapy.

What Is the Treatment for Leukemia?

According to the type and stage of leukemia, the oncologists tailor the treatment. The overall health conditions of the patient and the associated disorders will influence the treatment.

Some of the treatment options for leukemia are included below.

• Chemotherapy.

• Radiation therapy.

• Immunotherapy.

• Stem Cell transplantation.

• Bone marrow transplantation.

• Targeted therapy.

• Chemotherapy involves either a single drug or a combination of drugs.

• Radiation therapy radiation will kill the cancer cells and help inhibit cancer cell growth.

• Immunotherapy or biological therapy.

• Stem cell transplantation involves the transplantation of healthy bone marrow in place of diseased bone marrow.

• Autologous transplantation is called the transplant obtained from the own individual, and allogeneic transplantation refers to the transplant obtained from the donor.

• Targeted therapy includes Imatinib, Nilotinib, and Bosutinib.

What Are the Complications of Leukemia?

The complications of leukemia occur primarily due to the chemotherapy and the immunosuppressive conditions present in the host. In addition, leukemia may occur in association with certain disorders.

Some of the complications of leukemia due to the factors associated with leukemia are given below.

• Tumor lysis syndrome or TLS.

• Disseminated intravascular coagulation or DIC.

• Infections.

• Other types of cancer.

What Is the Differential Diagnosis of Leukemia?

Leukemia has numerous differential diagnoses due to its broad, nonspecific symptoms. It is crucial to distinguish leukemia from other infections, drug effects, vitamin deficiencies, and other myelodysplastic disorders.

Some of the differential diagnoses of leukemia are listed below.

• Vitamin B12 deficiency

• Folate deficiency.

• Viral infections include human immunodeficiency virus (HIV) and Epstein-Barr virus.

• Cytomegalovirus.

• Drug reactions include Valproic acid, Ganciclovir, and Mycophenolate mofetil.

• Autoimmune conditions include systemic lupus erythematosus or SLE.

Conclusion

Leukemia is a blood cancer caused due to abnormal production of white blood cells in the bone marrow. The exact cause of leukemia is unknown. The common symptoms of leukemia include recurrent infections, weight loss, easy bruises, rashes, bleeding, and fever. Symptoms may vary in different types of leukemia, and the treatment is done according to the type. Proper guidance and therapy advised by the doctor are effective management to reduce the adverse effects and improve the quality of life.