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Review
. 2021 Mar;100(3):615-625.
doi: 10.1007/s00277-020-04349-z. Epub 2020 Nov 20.

Skin changes in hairy cell leukemia

Ewa Robak  1 , Dorota Jesionek-Kupnicka  2 , Tadeusz Robak  3   4
Affiliations
Review

Skin changes in hairy cell leukemia

Ewa Robak et al. Ann Hematol. 2021 Mar.

Abstract

Skin lesions have been reported in about 10-12% of hairy cell leukemia (HCL) patients. Most are etiologically related to autoimmune or infectious processes, although secondary cutaneous neoplasms and drug-induced lesions are also reported. However, leukemia cutis with the direct infiltration of the skin by leukemic cells is extremely rare in HCL patients. This paper reviews the epidemiology, pathogenesis, clinical symptoms, diagnosis, and approach to treating skin lesions in HCL. A literature review of the MEDLINE database for articles in English concerning hairy cell leukemia, skin lesions, leukemia cutis, adverse events, infectious, cutaneous, drug reactions, neutrophilic dermatoses, secondary neoplasms, and vasculitis was conducted via PubMed. Publications from January 1980 to September 2020 were scrutinized. Additional relevant publications were obtained by reviewing the references from the chosen articles.

Keywords: Adverse drug reactions; Cladribine; Cutaneous; Hairy cell leukemia; Infectious; Interferon; Leukemia cutis; Melanoma; Neutrophilic dermatoses; Secondary cancer; Skin; Skin neoplasms; Vasculitis; Vemurafenib.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Maculopapular skin rash due to paraneoplastic dermatitis with cutaneous leukocytoclastic vasculitis on upper and lower extremities at diagnosis of HCL. Similar lesions were present on the chest, back, and neck. Skin biopsy with granulocytic and lymphocytic inflammation in small and large vessels in subcutaneous tissue (a, b, c) (HE × 20, × 100, × 200); fibrinoid necrosis and leukocytoclasis (fragmented neutrophilic nuclei) (c) with destruction of vessel wall (immunohistochemical staining for desmin, DAKO, × 200) (d)
Fig. 2
Fig. 2
Ulcerative pyoderma gangrenosum on the right tibial surface in the patient with hairy cell leukemia before treatment. Lesions completely resolved after treatment with cladribine treatment
Fig. 3
Fig. 3
Herpes zoster infection in a patient with hairy cell leukemia treated with cladribine
Fig. 4
Fig. 4
Ecthyma gangrenosum in the patient with hairy cell leukemia associated with Pseudomonas aeruginosa bacteremia, manifested as painless red macule with surrounding erythema, followed by hemorrhagic bullae and cutaneous ulcerative lesions
See this image and copyright information in PMC

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