Hodgkin's lymphoma, skin manifestations C81.9

S.u. Hodgkin's lymphoma

Specific skin lesions (0.5-3.5% of patients):

• Blurred, squamous or nodular infiltrates.
• Single, multiple, or papulo-nodular exanthema-impressing, brownish to livid-red, cutaneous-subcutaneous nodules.
• Tendency to ulceration: lymphogranulomatous ulcer, especially on the trunk, lower abdomen, inguinal and thigh regions, and head.
• Specific infiltrates in the lymphatic pharyngeal ring with tendency to ulceration.

Nonspecific skin lesions (in 30-50% of patients):

• Pruritus: Excruciating pruritus with scratching effects, impetiginization, eczematization and lichenification, erythroderma, blistering, which can hardly be influenced by medication,
• Chronic prurigo (old name: prurigo lymphogranulomatotica)
• Hyperpigmentation: Diffuse, morbus-Addison-like hyperpigmentation on skin and mucous membranes.
• Ichthyotic skin lesions
• Zoster generalisatus
• Pyoderma
• Molluscum contagiosum (dissemnierts occurrence possible, see Fig.)

Autoimmune diseases and Hodgkin's lymphoma: Hodgkin's lymphoma is associated with various autoimmune diseases or diseases from the atopic form circle (Landgren O et al. 2006). These include:

• Ulcerative colitis
• Atopic diseases (atopic dermatitis, bronchial asthma - Rafiq M et al 2020).
• Rheumatoid arthritis
• Systemic lupus erythematosus (Rahman A et al. 2007).
• Sarcoidosis
• Immune thrombocytopenic purpura
• Paraneoplastic pemphigus (Wang N et al. 2015)
• Mucinous pemphigoid (Durmus Ö et al 2020).

General symptoms of Hodgkin's lymphoma:

• Initial symptoms are often lymph node enlargement, especially in the neck and axillae. Furthermore B symptoms: weight loss, night sweats.
• In about one third of patients, lymph node pain a few minutes after alcohol consumption, relapsing lymphogranulomatous fever (Pel-Ebstein fever) with recurrent character.
• In early stage: Few days of fever alternating with fever-free intervals. In the late stage: appearance of Pel-Ebstein fever with retroperitoneal lymphoma. For detailed clinic and diagnosis see below. Hodgkin's lymphoma.

Depending on the cell infiltrate, a distinction is made between 5 different forms (see also under Hodgkin's lymphoma):

1. Diffuse lymphocytic and/or histiocytic form (approx. 5% of cases).
2. Nodular lymphocytic and/or histiocytic form (approx. 80% of cases)
3. Mixed cell form (approx. 10-15% of cases)
4. Diffuse fibrosis (approx. 1% of cases)
5. Lymphocyte-poor form (approx. 1% of cases)

In the early phase, reticulum cell proliferations are seen in the lymph nodes, then an interspersion with neutrophil and eosinophil granulocytes, scarring, mononuclear (Hodgkin cells) and multinucleated (Sternberg-Reed giant cells), and atypical reticular cells. Skin biopsies are often less characteristic. Hodgkin and Sternberg-Reed cells are CD30/MIB1 positive.

An assignment of the specific skin infiltrates to the individual Hodgkin subtypes has not yet been made.

Polychemotherapy or radiotherapy by haematologists or radiotherapists. For further details see below. Hodgkin's lymphoma.

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