Skin Reactions to Rituximab/Rituxan?

[TigerM]

I finished 4 rounds of Rituxan for B-cell NHL about 45 days ago. Overall I feel amazing! Thanks for asking. What's weird is what's happening on my skin. I have blisters popping up on my right arm, chest, and now one on my scalp. The ones on my arm and hand jumped up quickly and disappeared just as fast. Same with the scalp. The ones on my chest won't go away. Has anyone experienced this? Any suggestions? Does sun exposure make it worse? Thanks in advance. Many prayers and much love to all of you.

[lankisterguy]

Hi TigerM,

I have CLL which is the most common B-cell NHL, so this may or may not be helpful for you.

I have had a rash on my legs, arms and torso (mostly small light red dots connected in a web pattern –most days no itch or discomfort) since 2006 before my CLL diagnosis in 2008.

Each of the 4 times I was treated for my CLL it got visibly worse, but Ibrutinib made it much worse- angry red & itchy.

When I paused Ibrutinib my skin was back to normal (my own normal light red dots) in 2 weeks, and restarting Ibrutinib after 4 weeks made it angry red quickly.

Over the years I've had many biopsies; dermatologists and pathologists postulated Psoriasis, Eczema, drug reactions, and more recently CTCL or Mycosis Fungoides.

The common result from expert pathologists that ran flow cytometry on the biopsy, was finding many T-cells and CLL cells in a specific layer of my skin. But the puzzle is why they are there.

My most successful treatment was Photo therapy (lightbox treatment with UVB rays 3X per week- similar to a stand up tanning bed, but with medical precision on light frequency and duration).

In winter - dry cold weather, if it becomes itchy and bothersome, I use Triamcinolone Acetonide (prescription steroid cream) for 2-3 days then switch to a good moisturizer like CeraVe until the rash is well controlled.

The most recent diagnosis by a research pathologist eliminated CTCL and its cousins, but attributed it to T-cell Dyscrasia.

ncbi.nlm.nih.gov/pubmed/176...

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Our archives has over 3,000 replies that mention skin issues and CLL:

healthunlocked.com/search/p...

The NIH has several papers suggesting that CLL itself leads to skin issues, as noted here:

ncbi.nlm.nih.gov/pubmed/174...

SNIP: "Cutaneous lesions occur in up to 25% of patients with chronic lymphocytic leukemia (CLL). These can be caused by either cutaneous seeding by leukemic cells (leukemia cutis, LC) and other malignant diseases or nonmalignant disorders. Skin infiltration with B-lymphocyte CLL manifests as solitary, grouped, or generalized papules, plaques, nodules, or large tumors.....The most common secondary cutaneous changes seen in CLL are those of infectious or hemorrhagic origin. Other secondary lesions present as vasculitis, purpura, generalized pruritus, exfoliative erythroderma, and paraneoplastic pemphigus. An exaggerated reaction to an insect bite and insect bite-like reactions have been also observed".

My own experience is that skin rashes and irritation started a year before I was diagnosed in 2008, and any time I got treatment for my CLL, it got worse. But Ibrutinib/Imbruvica really ramped it up to painful levels.

So perhaps my skin doesn't like CLL but Imbruvica really makes it angy.

I suggest you have a good cancer oriented dermatologist do a full body inspection of your skin every 6 months (we get skin cancer at 5x to 8x more often than non-CLL people- and the only way to detect it early is get an expert examination) and helping your treat your sores will be part of that care.

Len

[TigerM in reply to lankisterguy]

Len-First off, thank you for sharing. Having NHL is both a blessing and a curse. It has made me more appreciative of the life I have and my faith in God increased by this experience.

Initially the pathologist thought I had CLL but that was quickly ruled out through the testing. I'm diagnosed with B-cell NHL and have recently completed 4 rounds of Rituxan. The rash on my chest popped up about 7 weeks after the treatment ended. At first I wasn't concerned but then little blisters kept coming out on my right hand, arm and leg. Then I went to Puerto Rico for a week and when I got back the rash on my chest got worse, itching and burning and spreading up my neck...on a Friday, of course.

I contacted my oncologist who said it wasn't from the Rituxan. I knew I couldn't wait to get the referral from my PCM to dermatology so I made my own appoitment and paid cash. The NP also said it could be psoriasis, or a form of eczema brought on by an autoimmune reaction to the cancer/treatment. She said our bodies stress, even if we don't recognize it, and take it out on healthy skin, organs, or joints. Apparently mine, like yours, is skin. I did have a scrape and punch biopsy to narrow it down and make sure we aren't overlooking something. She prescribed me betamethasone dipropionate ointment and it made the rash much better overnight. For that I am most thankful. This stuff hurts!

Apart from the rash I feel amazingly improved. The Rituxan hurt like heck the first time, sort of hurt the second time, and was fine the 3rd & 4th. About 6 weeks after the end of treatment I noticed how good I felt. I liken the downturn to the frog in the pot of water. It gets heated up slowly until the frog doesn't know the danger it is in. My cancer worked like that. I didn't realize I was sick until I realized I was sick. Then when I felt better it was awesome! LIke a gift.

You've been 10 years into this. How are you doing? My love and prayers to you.

[TigerM in reply to lankisterguy]

Hi Len. Oh goodie we got the rash on my chest to stop just in time for it to spread to my neck, face, and scalp. I have a message into my oncologist. It hurts! Plus I have a sore throat that feels like the rash on the outside. When I met with her last week she did say it was a reaction to treatment. She said I should take steroids after any future treatment. So for now it is an unfortunate side effect of feeling better!

[BLP1211]

I Hope all continues to go well.