Skin rash in pediatric cancer patient - a case in point

Melinda Chu, M.D., St. Louis, points to an example of how looks can deceive when deciding whether to treat skin rashes in pediatric patients undergoing cancer treatment.

She saw a patient who presented with yellowish hyperkeratotic plaques - evidence of graft versus host disease (GVHD). The flaky rash covered the patient’s face. GVHD often is considered life-threatening.

“However, there are different grades of GVHD. While it definitely can kill people with leukemia, oncologists can actually see a low-grade GVHD as a good thing,” Dr. Chu says. “Low-grade GVHD means that the patient’s immune system is active. And when there’s graft versus host there’s also graft versus leukemia going on.”

Dr. Chu and colleagues considered aggressive treatment to get rid of the skin manifestation, but the rash wasn’t bothering the patient. Medications to treat it would increase immunosuppression, which would have affected all of the patient’s other defense systems and increase risk of infection.

Without therapy to treat the rash, the patient has improved but is not completely clear, according to Dr. Chu.