Introduction:
A skin rash is any change in the color, appearance, or texture of the human skin, and it can be localized in one area or generalized. The causes and the treatments may also vary. The diagnosis must consider the appearance, other symptoms, occupation of the patient, exposure to etiological agents, and the occurrence in family members.
What Are the Causes for Different Types of Skin Rash?
The common causes for rashes include allergy to food, medication, coloring agents, insect bites, chemicals, and metals. It could also be due to infections, skin diseases, exposure to heat or friction, and rarely autoimmune disorders or cancer. Thus it can develop due to many reasons, most of which are not cancer. Even in this case, we need to identify the underlying cause and treat it accordingly.
What Is Cancer?
Cancer is the uncontrolled growth of abnormal cells that can occur anywhere in the body. When they invade the other parts of the body, it is termed metastasis. Skin cancer is one of the most common cancers in the body, but not all skin cancer can cause a rash. Sometimes, unexplained skin rash can be cancer also. When there is itchy skin without a rash, it could signify cancer.
What Are the Different Types of Cancer-Causing Skin Rash?
Mycosis Fungoides-
It is also known as Alibert-Bazin syndrome or granuloma fungoides, and it is the most common form of cutaneous T-cell lymphoma. It is commonly diagnosed in people over the age of 50 years, and it is often characterized by scaly, red patches of skin. They are generally present on the lower abdomen, thighs, and buttocks and are itchy. As the growth continues, it develops into raised lesions called plaques. They are purple or brown and can develop into tumors.
Sezary Syndrome-
Sezary syndrome is a rare type of peripheral T-cell lymphoma. It is characterized by erythroderma (intense and widespread reddening of the skin), enlarged lymph nodes, presence of Sezary or Lutzner cells (atypical circulating lymphocytes with grooved nuclei), alopecia, keratoderma, hypertrophic nails, lichenification, and outer turning of the lower eyelid. Like mycosis fungoides, they affect the elderly population. They are localized to the skin, with erythematous plaques present as single or multiple lesions in the thighs. They are itchy and can grow slowly.
Leukemia-
Leukemia is a group of blood cancers that usually begin in the bone marrow and result in abnormal blood cells. The symptoms include bleeding and bruising, bone pain, persistent fatigue, fever, unexplained weight loss, a rash of tiny red spots clustered together, and an increased risk of infections.
Kaposi Sarcoma-
It forms nodules that begin in the blood or lymphatic vessels and causes purple-colored lesions on the face, feet, and legs that are painless, flat, or raised. It can also appear in the mouth or genital area. It is caused by a combination of immune suppression (like HIV) and infection by the human herpesvirus-8.
How to Identify?
In basal cell carcinoma, the skin lesion starts as a rash that resembles psoriasis. Later an indentation may form on the skin and begins to ooze blood in the center. A cancerous rash often does not resolve on its own, unlike a noncancerous rash.
Diagnosis of sezary syndrome:
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Excisional biopsy of the lymph node.
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Peripheral blood showing atypical lymphocytes.
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Immunophenotyping showing T-cell origin.
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Erythroderma involves greater than 80% of the body surface area.
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Absolute sezary cell count of at least 1000 cells/microL.
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Clonal TCR rearrangement is confirmed by PCR or Southern blot.
After diagnosis, tests are done to determine if cancer cells have spread from the skin to other parts of the body. It includes;
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Chest x-ray.
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PET (positron emission tomography) scan.
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Bone marrow aspiration and biopsy.
How to Treat Them?
Photodynamic Therapy:
It involves using a drug that is not activated until exposed to a specific type of laser light. The drug is injected into a vein. It collects more in cancer cells than normal cells. On exposure to laser light, the drug becomes active and kills the cancer cells. There are different types of photodynamic therapy, such as psoralen and ultraviolet A (PUVA) therapy and extracorporeal photochemotherapy.
Radiation Therapy:
Total skin electron beam radiation therapy, an external radiation therapy, is used to treat mycosis fungoides and sezary syndrome. This uses high-energy x-rays to kill cancer cells or restrict their growth. Ultraviolet A (UVA) or ultraviolet B (UVB) radiation therapy may be given using a special lamp to kill the tumor cells.
Chemotherapy:
It involves using drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Taking these drugs by mouth or getting them injected into a vein or muscle can enter the bloodstream to kill the cancer cells throughout the body. Sometimes, it is in a topical cream, lotion, or ointment form.
Other Drug Therapy:
Topical steroids are used to relieve pain and redness of the inflamed skin. Lenalidomide helps the immune system to kill abnormal blood cells or cancer cells. Retinoids can be used to slow down the growth of these cells. Drugs like Vorinostat and Romidepsin can stop the tumor cells from dividing.
Immunotherapy:
This treatment uses the patient’s immune system to fight against cancer.
Targeted Therapy:
Monoclonal antibody therapy is a type of targeted therapy where drugs are used to attack tumor cells. Mogamulizumab is a monoclonal antibody that is used in the treatment of mycosis fungoides and Sezary syndrome.
High Dose Chemotherapy and Radiation Therapy With Stem Cell Transplant:
High doses of chemotherapy and radiation therapy kill the cancer cells, but the healthy blood-forming cells are also destroyed. Hence, immature stem cells taken from the patient or donor are frozen and stored. These are stored cells later infused into the patient to grow.
Conclusion:
Some cancers can lead to a rash, so it is vital to be aware of the signs to look out for. Examining the skin regularly and educating yourself about skin cancer will help you identify the changes to act quickly.
