Lymphoma Rash Symptoms and Treatment

When Marisa Sipcic noticed a rash all over her body in 2017, Sipcic thought it was an allergic reaction of some kind—and the doctor agreed. Within two years, the 26-year-old was having chemotherapy for stage 4a Hodgkin's lymphoma.

When nothing worked for what was believed to be an allergic reaction, Sipcic was put on steroid tablets, which did clear up the rash—but an "uncontrollable" itch remained. Meanwhile, Sipcic was always very tired and started experiencing night sweats. Sipcic didn't know that these are all common symptoms of Hodgkin's (also called Hodgkin) lymphoma, a cancer that begins in certain white blood cells.

It wasn't until one morning in August 2019, when Sipcic woke up to a golf ball–size swelling on the side of her neck, that Sipcic became concerned. Sipcic returned to the doctor, and after scans and a biopsy, was diagnosed with stage 4a Hodgkin's lymphoma. Fortunately, Sipcic entered remission within five months of chemotherapy, which uses drugs to kill cancer cells.

Here's what to know about lymphoma rash.

Symptoms of Lymphoma

Lymphoma can cause different symptoms depending on its type and location. Common symptoms include:

• Itchy skin
• Painless, swollen lymph nodes in the groin, underarm, or neck
• Persistent fatigue
• Trouble breathing, chest pain, and coughing
• Unexplained fever
• Unexplained weight loss within the past six months
• Very heavy sweating while sleeping

However, not everyone with lymphoma has symptoms early on. In addition, many of these symptoms can have other potential causes. Either way, it's best to see a healthcare provider to find out the cause.

Lymphoma rash is much more common among people with non-Hodgkin's lymphoma than Hodgkin's lymphoma.

Symptoms of Lymphoma Rash

Some people with lymphoma—particularly those with skin lymphoma—can experience the following symptoms on their skin:

• Nodules or tumors (large lumps or bumps under the skin)
• Papules (small lesions that resemble pimples)
• Patches (flat lesions)
• Plaques (thick, lowered, or raised lesions)

These lesions are often scaly and itchy and may range from red to purple. Large lesions can break open in some cases.

Non-Hodgkin's lymphoma can start in two types of white blood cells: T or B. Lymphoma rash is often, but not always, the result of cutaneous T-cell lymphoma (CTCL), a form of skin lymphoma that starts in T-cells. Mycosis fungoides, a type of CTCL, is the most common form of skin lymphoma.

For people with mycosis fungoides, skin symptoms might start as a rash on an area of the skin that gets little sunlight. A person may then experience light spots on the skin or flat, scaly patches. As mycosis fungoides spread, a person may develop raised and often itchy patches of thick skin and might develop tumors that look like sores if they split open.

Some people with lymphoma experience an itchy rash over most or all of the body. Their skin may peel and swell. Sometimes, the skin may thicken on the palms, soles, or both. This is particularly common among people with Sézary syndrome, a type of CTCL in which cancer cells are found both in the blood and the skin.

Skin itching is common among people with lymphoma, with or without a rash.

When To Contact a Healthcare Provider

Having a rash doesn't necessarily mean you have lymphoma. You could develop a rash for many reasons, and most of them have nothing to do with cancer.

However, it's best to contact a healthcare provider if you develop symptoms that may be due to lymphoma or another cancer. This could include a new lesion or abnormal area of the skin, especially if it is raised or growing, doesn't go away, or bleeds or breaks open.

Since lymphoma of the skin is often misdiagnosed, it's also a good idea to consult a board-certified dermatologist if you have been diagnosed with a skin disease like eczema and treatment doesn't reduce your symptoms. Dermatologists specialize in diseases that affect the skin, nails, and hair.

Lymphoma Rash Diagnosis

If you have skin symptoms you believe might be caused by lymphoma, a healthcare provider will ask about your medical history, including symptoms, risk factors, family history, and more. You might be asked whether your skin symptoms might have other culprits, such as allergies, taking a new medication, or using a new cream, lotion, or laundry detergent.

A healthcare provider will generally provide a physical exam to examine any affected areas of your skin and check the rest of your body for skin symptoms. They will also check whether lymph nodes are swollen and possibly perform a lymph node biopsy, which involves removing lymph node tissue and sending it to the lab to be examined for signs of lymphoma.

A healthcare provider will also perform a skin biopsy to diagnose lymphoma of the skin. This will distinguish skin lymphoma from more common skin diseases like eczema. Other tests might include:

• Blood tests that check liver function, kidney function, and more
• Bone marrow biopsy to check for lymphoma cells in bone marrow
• Complete blood count to check for anemia, white blood count, and abnormal cells
• Imaging tests (such as CT scans and PET scans) to check for signs of lymphoma elsewhere in the body

Physical exams, biopsies, blood tests, and imaging tests will also help a healthcare provider determine the stage of the cancer (how far it has spread).

Lymphoma Treatment

Treatment varies based on factors such as the type of lymphoma, its stage, and a patient's symptoms, age, and health. Some people may not need treatment immediately if their cancer is growing slowly, but they will still receive periodic exams.

Once treatment is necessary, some common treatments include:

• Chemotherapy: Medications are used to kill fast-growing cells, including cancer cells.
• Radiation therapy: High-powered radiation (such as X-rays) is used to destroy cancer cells.
• Targeted therapy: Targeted therapy uses drugs to disable cancer cells. It is less likely to harm healthy cells than traditional chemotherapy.
• Retinoids: Retinoids, drugs derived from vitamin A, are used to treat some types of skin lymphoma. However, anyone taking retinoids should not become pregnant, as retinoids can lead to severe birth defects.

Early treatment of skin lymphoma often focuses on treating the skin lesions themselves. Radiation therapy and chemotherapy may be used for this purpose. Some chemotherapy drugs can be applied to the skin in the form of cream, gel, or ointment to treat early-stage skin lymphoma. A healthcare provider may also prescribe other topical medications.

When skin lesions are thin, a patient may receive phototherapy, which uses UV light to destroy cancer cells in the skin. In other cases, skin lesions can be removed with surgery, but this typically isn't necessary.

A Quick Review

Lymphoma can have many symptoms, including what is known as lymphoma rash. Contact a healthcare provider if you notice any abnormalities in your skin.

Lymphoma is rare, and skin abnormalities can have many causes. However, if you have lymphoma, several treatments are available, such as chemotherapy and radiation therapy. Cancer support groups can also help you feel less alone.