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Four Things CLL Patients Should Know About Skin Issues

Four Things CLL Patients Should Know About Skin Issues
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Published on September 13, 2021

How CLL Can Impact the Skin, Hair, and Nails

The following article includes highlights from the CLL Answers Now series.

When Michele Nadeem-Baker notices her skin breaking out, she has to wonder if it is connected to her chronic lymphocytic leukemia (CLL) diagnosis or caused by something else. She is not alone. Some people with CLL experience skin lesions and other dermatologic issues. Many also report hair loss and nail damage.

Nadeem-Baker, a patient advocate and former broadcast journalist, recently hosted a CLL Answers Now program to explore the correlation between CLL and skin issues with experts Jennifer Woyach, MD, a hematologist-oncologist, and Brittany Dulmage, MD, a dermatologist specializing in oncodermatology, both from The Ohio State University Comprehensive Cancer Center in Columbus.

Here are four key takeaways for CLL patients and their care partners:

1. Skin issues can occur before you start treatment.

While some dermatologic problems, like hair loss from chemotherapy, are commonly associated with cancer treatment, CLL can trigger skin issues on its own, even while a patient is still on watch and wait. Dr. Woyach explained why.

“One of the hallmarks of the disease is that the immune system doesn’t work the way it’s supposed to,” she said. “For the most part, this is going to be immunosuppression, so making people predisposed to skin cancers, infections, and other conditions that prey on an immune system that’s not functioning appropriately. On the other hand, we also see autoimmune conditions in CLL where the body actually starts attacking its own components. So too much of an immune system that is not performing the way it’s supposed to, or too little immune system, can both lead to skin conditions.”

2. Some dermatologists specialize in CLL.

Nadeem-Baker said that when she was diagnosed with CLL, she already had a dermatologist. She didn’t realize at the time how important it is to see one who understands CLL.

“Certainly, a general dermatologist can do the annual skin exams and make sure that no skin cancers are developing,” said Dr. Woyach. “But some of those conditions where you’re not sure if they’re related to the CLL or not, those are probably best served by a sub-specialist.”

Dr. Dulmage agreed and explained the role of oncodermatology. “An oncodermatologist is someone who has gone through general dermatology training and has a specialty interest in caring for patients who have cancer of some type,” she said. An oncodermatologist performs skin screening exams and picks up on skin changes or new lesions that might be precancerous or cancerous, Dr. Dulmage explained. This type of dermatologist can also help with general skin care and offer advice on managing side effects from cancer treatment that affect the skin, hair, and nails.

Dr. Woyach recommends asking your healthcare provider to refer you to a dermatologist if you experience any issues with your skin, hair, or nails. If you had to look beyond your local area to find a CLL specialist, you may also need to expand your search when looking for an oncodermatologist.

3. Skin cancer prevention is critical.

According to a 2019 study published in Blood Cancer Journal, there is a correlation between skin cancer and melanoma. Dr. Woyach echoed this reality during the program. “Those basal cell and squamous cell cancers are the most common cancers we see in people with CLL,” she said. “We also see a higher-than-expected incidence of melanoma.”

Dr. Dulmage gave a thorough overview of skin cancer prevention best practices, including wearing a wide-brimmed hat and long-sleeved shirt when you’re outside, staying out of the sun at peak hours, and reapplying sunscreen frequently. She also explained that the type of sunscreen you use, as well as its SPF, matters.

“Sunscreens should be SPF 30 at a minimum,” said Dr. Dulmage. “I even recommend SPF 50 for patients who have risk factors. The sunscreen should be broad-spectrum, which means they have UVA and UVB protection. Ideally, they also should have a mineral ingredient as one of the active ingredients. When you flip that sunscreen over and look at the drug facts, it should have zinc or titanium as one of your active ingredients. The reason that’s preferred is those actually sit on top of the skin and provide a barrier to the sun reaching the skin. The chemical ingredients allow the sun to reach the skin but deflect the damage to the DNA.”

Both doctors emphasized the importance of getting a skin cancer screening every year, or more frequently if you have a family history of skin cancer or other skin cancer risk factors beyond CLL.

4. Not all patients will experience dermatologic issues.

Nadeem-Baker wants CLL patients to know that even though she and the experts discussed everything from melanoma to hair loss to discolored fingernails, those issues will not affect everyone living with CLL. “I don’t want you to think all of these things are going to happen to you,” she said. “Some people don’t get any of these, some get more than others, and some maybe have one. But it’s better to learn about these things and have the knowledge and know what to look for should they happen. And stay on top of your skin checks.”

Bonus Takeaway: The last question of the program diverged from skin care and focused on CLL and COVID-19. It aired just days before the Centers for Disease Control and Prevention recommended a third dose of the Pfizer and Moderna COVID-19 vaccines for immunocompromised people, so Nadeem-Baker asked the experts for their thoughts.

“I would definitely encourage CLL patients to go out and get a third booster shot when it’s available,” Dr. Woyach said. “What we’ve seen more anecdotally with CLL patients, and a little bit better studied in other immunocompromised patients, is there is actually a significant benefit to that third booster shot. So yes, I 100% agree with CLL patients getting a booster shot.”

To watch replays of past programs, visit the CLL Event Series page. For questions about your health and personal risk factors, please make an appointment with a CLL specialist.

~Suzanne Mooney

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Sponsorship statement: Support for this series has been provided by Janssen Oncology and Pharmacyclics LLC. Patient Power maintains complete editorial control and is solely responsible for program content.

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