Teen Discovers ‘Stress Rash’ is Actually Lymphoma

By Steve Blanchard - March 24, 2022

When we undergo stressful situations, such as a breakup, competing deadlines or changes in a career, our bodies sometimes show signs of fatigue, especially on our skin. But a rash can sometimes be much more serious than a sign of stress and should be seen by a dermatologist as soon as possible.

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 of which 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.”

That is exactly what a 19-year-old British woman experienced when she noticed a rash on her collarbone. Zara Barton told The U.S. Sun that she decided to see a doctor when the rash turned into hives and the spot on her collarbone formed a lump.

When antihistamines and creams didn’t help her condition, her doctor decided to check for blood cancer. Barton learned she had Hodgkin lymphoma.

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.

portrait of blockquote author

"These cells present with nodules or a rash that is related to the infiltration of the lymphoma directly into the skin."

- Dr. Hayder Saeed, Malignant Hematology Program

“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.”

Saeed said this type of rash, or pruritus, is related to Hodgkin lymphoma being a rapidly proliferative disease that releases inflammatory markers 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.

Rashes are rare in lymphoma patients but they are worth discussing with your doctor, Saeed said. And these rashes don’t occur only early in the disease’s development. Sometimes a rash will occur during treatment, well after the diagnosis.

“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 with a rash, especially if they have specific allergies.

Barton said she wanted to share her story because she wants others to know the importance of discussing changes in your body with your doctor, no matter how insignificant you may think they are. She is undergoing treatment and is speaking out for lymphoma awareness.

Saeed echoes that need for awareness. 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.”

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