The skin manifestations associated with leukaemia and allied conditions / Sir Humphry Rolleston, Bt., K.C.B., M.D., D. Sc., P.R.C.P.

  • Rolleston, Humphry Davy, Sir, 1862-1944.
Date:
[1924?]
Catalogue details

Licence: In copyright

Credit: The skin manifestations associated with leukaemia and allied conditions / Sir Humphry Rolleston, Bt., K.C.B., M.D., D. Sc., P.R.C.P. Source: Wellcome Collection.

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    Acute Leukaemia. It is difficult to draw a hard and fast line between acute leukaemia on the one hand, and subacute cases and latent cases with acute terminal phenomena on the other hand ; but a duration of symptoms for not more than three months may perhaps be taken as satisfactory for a diagnosis of the acute form. Acute leukaemia is now generally regarded as usually myeloid rather than lymphoid in character, and due to changes in the bone-marrow, the cells which pass into the blood being myeloblasts rather than lymphocytes or myelocytes. In the late stages the exhaustion of the bone-marrow may lead to a leucopenia, so that the condition is described as showing an aleukaemic phase {vide Sequeira and Panton). No attempt will be made here to differentiate the cutaneous manifestations of acute leukaemia into those associated with acute myeloid and those with acute lymphoid leukaemia. The cutaneous lesions in acute leukaemia fall into the distinct groups of (i) definite leukaemic tumours, and (ii) various other changes, sometimes spoken of as dermatoses. (i) The cutaneous tumours formed of leukaemic cells resembling those in the blood are much the same in appearance, namely, plum-coloured, nodular, discoid, or flattened, as those seen in chronic leukaemia ; usually they are quite small, and, though they may be extremely numerous, rarely become confluent, as may occur in chronic leukaemia. In some cases, for example, that reported by Shaw and Loughlin, the total white count was not increased, though the differential count supported the diagnosis of an aleukaemic phase of acute lymphoid leukaemia. This con¬ trasts with H. W. Barber’s case of acute lymphoid leukaemia, slaty blue, plum-coloured nodules appearing first on the scalp, where one ulcerated, and later on the body, with a total white count of 400,000. Cases of multiple cutaneous tumours with the histological structure of leukaemic nodules, but without any characteristic blood changes, such as Lavenson’s case of “ acute leucopenic lymphatic leukaemia,” cannot be regarded as leukaemia. (ii) Cutaneous rashes are commoner in acute than in chronic leukaemia, and they are polymorphic, thus suggesting that their exciting cause is not necessarily always the same. Acute leukaemia has many of the features of an acute infection, but it differs from any one of the acute exanthems, such as scarlet fever, in the various forms of skin eruptions