CLL and Granuloma Annulare

[Catskillady]

I have had CLL since 2006, I was 59 years old when I was diagnosed. I have had chemo with RCD twice, 6 treatments in 2008 and 3 in 2013. I have a number of negative prognosticators, ZAP 70, trisomy 12, CD 38. I developed a rash about 3 months ago. 2 dermatologists have done biopsies which show Granuloma annulare. I have done some research on CLL with this skin disorder and have found some alarming information about this possibly being a precursor to lymphoma. My WBC is rapidly going up, my nodes are enlarged and my MD is considering starting Ibrutinib in the near future. Does anyone have any information about this? I am very disappointed that my MD and both dermatologists told me that this skin disorder has nothing to do with my CLL, I now think they are trying to shield me from the truth.

[AussieNeil Partner Administrator]

Hi Catskillady. CLL is a lymphoma - that's why many of us have swollen lymph nodes and other lymphoid system involvement with our CLL. (CLL/SLL is counted among the Non Hodgkin Lymphomas, with the CLL presentation more in the blood and SLL more in the lymphoid system. The B-cells have the same underlying mutations, so while CLL and SLL were historically considered different diseases, they are now internationally recognised as the same disease.)

Granuloma Annulare is a rare, long lasting chronic condition and is sometimes seen with CLL, where the B-cells appear in the skin:

ncbi.nlm.nih.gov/pubmed/228...

As it is more often seen with other lymphoma types, what should be resolved in your case, is whether the lymphoma cells in your skin where the Granuloma Annulare is apparent, are CLL cells or some other lymphoma type. That can be done by performing a flow cytometry test on a biopsy of you affected skin.

Given your MD is considering starting treatment with Ibrutinib in the near future for other reasons, you could consider that this is just another indication that shows, unfortunately, that you again need treatment for your CLL. If you are going on Ibrutinib soon, you might just be satisfied to see whether your Granuloma Annulare clears up then, particularly if the dermatologists haven't given you any cause for concern. Otherwise, see an experienced haematologist.

What's been suggested to you for controlling/treating the Granuloma Annulare?

Neil

[Catskillady in reply to AussieNeil]

I am using Lidex ointment, it clears up 5 pf the lesions and 6 new ones appear!

Thank you very much for your input, it was most helpful.

[Cllcanada Top Poster CURE Hero]

Check out this excellent Derm website from New Zealand...

dermnetnz.org/dermal-infilt...

[Quarry]

There is more info on Granuloma Annulare (GA) on nhs.uk/conditions/granuloma...

The good thing is that is looks like it self-clears....just needs time (of up to 2 years). My suspicion is your WBC count etc is due to CLL, not Granuloma Annulare (it looks like this is inconvenient, not life-threatening)

I too have a rash on the back of my left hand - GP gave me a bacterial cream that did nothing and I can't see any point in going back....but I have wondered what it is. (looking at GA pictures on the above site, I am not sure it is GA - maybe something different - but you post has taken me forward, so thank you!)

I treat with E45 when it gets really itchy and can live with it (it does not seem to be expanding). If it is GA, I have done 3 months...only 21 to go before self-clearing then.......

[Catskillady in reply to Quarry]

Thank you for your response. I find Lidex is helping a bit. Stay well!