What Does a Lymphoma Skin Rash Look Like? Stages & Treatment

Lymphoma skin rashes may be itchy and appear as red or purple with dry scales. Learn about skin lymphoma symptoms and treatment

Lymphoma skin rashes may be itchy and appear as red or purple with dry scales, especially along the skin folds. Irritation may sometimes occur with or without rash. Rashes appear as different types of lesions on the skin:

• Erythroderma (life-threatening inflammation of the skin that spreads over the body)
• Ulceration (skin lesions that break open):
  • Papules (small, pimple-like lesions)
  • Patches (flat lesions)
  • Plaques (thick, raised or lowered lesions)
  • Nodules or tumors (larger lumps or bumps under the skin)

While lesions are often noticed in the early stages, skin lymphoma is difficult to diagnose because the rashes may resemble other skin problems, such as eczema or contact dermatitis.

Skin lymphoma can also reach the lymph nodes (oval-shaped glands with a collection of the immune cells) causing them to enlarge. These lymph nodes may be felt as lumps in the armpits, groins, or other sites on the body.

What is skin lymphoma?

Skin lymphoma, also known as cutaneous lymphoma, is a rare type of lymphoma, or cancer of the immune system that develops in white blood cells, or lymphocytes. Lymphocytes are classified into two groups:

• Cutaneous T-cell lymphomas (CTCLs): T-cell skin lymphomas are also called mycosis fungoides; these are the most common type of skin lymphoma.
• Cutaneous B-cell lymphomas (CBCLs): B-cell skin lymphomas are much less common than T-cell skin lymphomas.

What are the stages of skin lymphoma?

Stages are used to classify the severity of the disease:

Stage I (only affects the skin in patches or plaques)

• Stage IA: Lymphoma affects less than 10% of the skin.
• Stage IB: Patches or plaques have become more widespread and affect more than 10% of the skin.

Stage II

• Stage IIA: Patches or plaques on the skin and lymph nodes are swollen, but there are no cancerous T cells there.
• Stage IIB: There are one or more lumps (tumors) in the skin.

Stage III

• Stage IIIA: Most of the skin (more than 80%) appears red and sore (erythrodermic mycosis fungoides).
• Stage IIIB: There are some Sezary cells (cancerous T cells) in the blood.

Stage IV

• Stage IVA1: A high number of Sezary cells (cancerous T cells) are found in the blood (Sezary syndrome).
• Stage IVA2: There are cancerous T cells in the lymph nodes.
• Stage IVB: Cancer has spread to other organs of the body such as the liver or spleen.

How is skin lymphoma treated?

Treatment of skin lymphoma is based on its type and stage. Treatment options include:

• Topical corticosteroids: Topical corticosteroids contain anti-inflammatory agents that kill lymphoma cells and are the first line of treatment. They can be given as cream or ointment to be applied directly to the skin or injections given directly into the affected areas.
• Chemotherapy (topical or in the form of tablets or injections): Topical chemotherapy agents are usually given along with corticosteroids. Chemotherapy works by blocking deoxyribonucleic acid (DNA) replication in cancer cells.
• Topical immunotherapy: One commonly used drug is Imiquimod, which clears skin lymphoma lesions when applied to the skin.
• Retinoids (oral or in the form of ointment): Retinoids are synthetic vitamin A medications that can cause certain types of cells to die. They are usually used when topical corticosteroids and chemotherapy agents are not effective.
• Phototherapy: Phototherapy uses two types of ultraviolet (UV) light (A and B) to destroy cancer cells.
• Radiation therapy: Total skin electron beam (TSEB) therapy penetrates only a few layers of the skin and does not have the severe effects of more invasive radiotherapy. Brachytherapy places radioactive isotopes under the skin for a period of time to kill cancer cells.
• Interferons: Interferons are cytokine compounds normally produced by the cells as a response to disease. Interferons are typically injected 3 times a week for 3-6 months.
• Histone deacetylase (HDAC) inhibitors: These work by targeting the cells’ DNA in a way that causes cancer cells to die.
• Extracorporeal photopheresis: Extracorporeal photopheresis takes the white blood cells out of a sample of a person’s blood, exposes them to UV light and puts them back into the bloodstream. The treated cells then act against the cancerous ones.
• Antibodies: The most commonly used biologic to treat skin lymphoma is monoclonal antibodies that are developed to recognize specific types of cancer cells. They work by targeting an antigen found on cancerous T cells.
• Stem cell transplant: The only known cure for cutaneous lymphoma is a bone marrow transplant, also known as a stem cell transplant. As a risky procedure, it is typically only done when the condition is very advanced or has come back repeatedly after other treatments.