Is Your Rash a Cold, the Flu or Lymphoma?

Most of the time a skin rash, fever, night sweats or fatigue are signs of a cold, flu or respiratory infection. But sometimes these symptoms can be signs of Hodgkin lymphoma, which often mimics conditions that are far more common and less serious.

Dr. Hayder Saeed, hematologist at Moffitt Cancer Center.

According to Moffitt Cancer Center hematologist Dr. Hayder Saeed, Hodgkin lymphoma can cause a skin rash or an itching sensation that can point to a greater underlying problem. Fortunately, it’s a rare occurrence, but one patients should be made aware.

“The most common rash that happens with Hodgkin lymphoma appears in up to 25% of patients at the initial diagnosis,” Saeed said. “It’s more of an itch than a rash but can lead to some discoloration and redness due to persistent itching, which can in turn lead to skin infection present at the rash.”

Saeed said this type of rash, or pruritus, is related to Hodgkin lymphoma being a rapidly proliferative disease that releases an inflammatory marker in the skin. If a rash occurs, it typically appears at the base of the neck, elbows, under the arms or in the groin area. There are instances, however, where a rash associated with this type of cancer can involve larger areas like the back or abdomen.

The hallmark symptom of Hodgkin lymphoma is painless swelling in lymph nodes in the neck, underarms or groin.

Non-Hodgkin lymphoma can also produce a rash, specifically cutaneous T cell lymphoma that directly involves the skin.

“These cells present with nodules or a rash that is related to the infiltration of the lymphoma directly into the skin,” Saeed said. “Of course, any time a rash presents itself, a patient should discuss it with their doctor.”

Rashes that occur with T-cell and B-cell skin lymphomas often have the following characteristics:

• In early stages, small patches of dry, red skin (mycosis fungoides) might appear on the torso, buttocks or other parts of the body.
• The rash may resemble psoriasis, eczema or dermatitis.
• Some affected areas of skin may also thicken, harden and form plaques, which can itch and ulcerate. Most often, plaques develop on the face, buttocks or in skin folds.
• As the lymphoma progresses, raised areas of skin (papules) may appear. Papules can potentially grow and form nodules or tumors.
• Some people also experience a general reddening of the skin known as erythroderma, which can be dry, itchy and scaly.

It’s important to remember that rashes like those described above are rare in lymphoma patients, but they are worth discussing with a medical professional. There are also instances where rashes appear after diagnosis of lymphoma.

“One of the essential medications used in treatment of Hodgkin lymphoma is immunotherapy with nivolumab or pembrolizumab,” Saeed said. “Those medications can lead to a form of irritated skin that needs to be monitored.”

Saeed said multiagent chemotherapy can also cause patients to present a rash, especially if they have specific allergies.

No matter where a patient is in their treatment, Saeed recommends paying close attention to your skin for signs of a recurrence.

“Even after therapy, patients who finished treatment for Hodgkin lymphoma can present itching or a rash as the first sign of a relapse,” he said. “Staying under observation and informing your oncologists of such symptoms is the best way to investigate it and ensure you’re receiving the best medical care.”