Association Between Myelodysplastic Syndromes (MDS) and Severe Eczema
There is no established association between myelodysplastic syndromes (MDS) and severe eczema based on current clinical guidelines and available evidence.
Understanding MDS and Its Clinical Manifestations
MDS represents a group of clonal hematopoietic stem cell disorders characterized by:
- Ineffective hematopoiesis leading to blood cytopenias 1
- Risk of progression to acute myeloid leukemia (AML) in approximately one-third of cases 1
- Predominance in elderly patients with a median age at diagnosis of approximately 70 years 1
Immune Dysregulation in MDS
While MDS is not directly associated with severe eczema, there is evidence of immune dysregulation in MDS that can manifest as various cutaneous conditions:
- Immune dysregulation has been implicated in MDS pathogenesis, with both innate and adaptive immune systems showing abnormal activity in the hematopoietic niche 2
- Epidemiological studies have shown associations between autoimmune diseases and MDS, with patients having antecedent autoimmune conditions showing an increased risk of developing MDS 2
Documented Skin Manifestations in MDS
The skin manifestations associated with MDS include:
- Cutaneous vasculitis (most frequent) 3
- Neutrophilic dermatoses including pyoderma gangrenosum, Sweet's syndrome, and erythema elevatum diutinum 3
- Granulomatous dermatitis (rare) that can precede the diagnosis of MDS by several years 4
- Relapsing polychondritis 3
Clinical Implications and Management
When evaluating patients with severe eczema and suspected hematological abnormalities:
- Consider complete blood count with differential, as cytopenias and monocytosis can be indicative of underlying MDS 4
- Early biopsy of unusual or persistent cutaneous lesions is indicated in patients with known MDS 3
- In patients with both MDS and immune-mediated skin conditions, treatments targeting immune dysregulation may be beneficial 5
Important Caveats
- The absence of specific mention of eczema in MDS guidelines suggests that there is no strong established association between severe eczema and MDS 1
- Skin manifestations in MDS are more commonly related to neutrophilic dermatoses and vasculitis rather than eczematous conditions 3
- When severe eczema and MDS coexist, they may represent independent conditions rather than a causative relationship 2, 6
Treatment Considerations
If a patient presents with both MDS and severe skin manifestations:
- Treatment should primarily target the underlying MDS according to risk stratification 1
- For lower-risk MDS with immune-mediated skin manifestations, immunosuppressive therapies may be considered 5
- For higher-risk MDS, hypomethylating agents like azacitidine may have both cytotoxic and immunomodulatory effects that could potentially benefit both conditions 1, 2