Pityriasis rubra pilaris (PRP) is a rare, chronic papulosquamous disorder that presents with scaling plaques, palmoplantar keratoderma, and keratotic follicular papules. Typically, there are distinctive unaffected areas referred to as "islands of sparing." Pityriasis rubra pilaris has been associated with various immunodeficient states and malignancies.The authors conducted a literature review using MEDLINE, PubMed, and Google Scholar, documenting all known cases of PRP associated with malignancy; 15 cases were found in the literature. They also present the case of a 49-year-old White man who, prior to referral to dermatology, was seen in urgent care for widespread pruritic rash. Physical examination in the dermatology clinic revealed confluent, scaly erythematous papules coalescing into plaques with island of sparing involving the trunk and upper and lower extremities. Bilateral palms and soles showed hyperkeratosis with fissuring. He was diagnosed with PRP after punch biopsy and began a new course of topical corticosteroid therapy. Hematology was consulted because of abnormal complete blood count results, and he was subsequently diagnosed with chronic lymphoid leukemia.Treatment of PRP is largely based on clinical experience and may involve corticosteroids, immunomodulators, or biologic therapy. The relationship between PRP and malignancy is unknown. Current theories postulate it may be driven by tumor production of functional peptides or antigen cross-reactivity between cancer cells and the skin. This is the second reported case of PRP as a manifestation of leukemia, and the first of chronic lymphoid leukemia.Although not yet understood, the documented relationship between PRP and malignancy prompts screening for cancer in all patients with new-onset PRP.
:Chronic myelomonocytic leukemia (CMML) is a rare hematopoietic stem cell neoplasm. Indeterminate dendritic cell neoplasm (IDCN) is an extraordinarily rare histiocytosis that may manifest secondarily to CMML. A 75-year-old man with a 2-year history of CMML presented for multiple cutaneous lesions on his head and neck. Biopsy results yielded a dense diffuse infiltrate of large pleomorphic cells, which were positive for CD1a, S100, and CD56 with weak positivity for CD43 and CD68. Given his history of CMML, the patient was diagnosed with IDCN. This may indicate a progression of his CMML or transformation to acute leukemia; therefore, a systemic workup was recommended. IDCN may manifest secondary to a wide number of hematopoietic malignancies, with CMML being a rare occurrence. Recorded responses to phototherapy are reassuring, whereas systemic therapy may be appropriate for widespread cases. Remaining vigilant for cutaneous changes in patients with CMML will help prevent misdiagnosis and encourage prompt initiation of appropriate treatment.
OBJECTIVETo review the literature on cutaneous reactions to the influenza vaccine in adults.DATA SOURCESAuthors systematically searched three databases: PubMed, MEDLINE, and EMBASE.STUDY SELECTIONCase reports published between January 1, 1995 and December 31, 2020 that described a cutaneous reaction to any brand of the influenza vaccine in adults were included. Exclusion criteria included having the wrong study design, pediatric cases, publication prior to 1995, and lack of cutaneous reaction to the vaccine.DATA EXTRACTIONA total of 232 articles were identified. After duplicate removal, title and abstract screening, and full-text screening, 29 studies were included in the final review. Data extracted included patient sex, age, type of influenza vaccine received, time from vaccine administration to cutaneous reaction, duration of cutaneous reaction, description of cutaneous reactions, treatments used, and the outcome (eg, resolution, reoccurrence, complications).DATA SYNTHESISThe mean age of participants was 43.7 years (range, 19–82 years), and 60% were women (n = 18). The most frequent cutaneous reaction that occurred following influenza vaccination included erythematous macules/papules/plaques (n = 17 [56.7%]), vasculitic and purpuric rashes (n = 5 [16.7%]), and maculopapular (morbilliform) rashes (n = 3 [10.0%]). All patients received treatment, and 96.7% (n = 29) of the cutaneous manifestations were resolved. Most studies did not report any further complications upon follow-up.CONCLUSIONSUnderstanding and identifying the relationship between the influenza vaccine and possible cutaneous manifestations can help providers predict and anticipate these adverse effects.
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