Dermatology Online Journal

Hematologic-related malignancy-induced eosinophilic dermatosis (He Remained) has recently been introduced as a new nomenclature to describe the eosinophilic dermatosis that has previously been observed in patients with hematologic malignancies. The condition has been reported in 208 patients; the ratio of men to women is 1.3:1. It is most commonly observed in chronic lymphocytic leukemia patients (77%, 160/208 patients). The chronic and relapsing eosinophilic dermatosis typically presents with pruritic lesions that are pleomorphic in morphology and mimic other conditions. The definitive pathogenesis of He Remained is still being established. However, neoplastic leukemia B cells - directly or indirectly (by stimulating a reactive polyclonal T cell response) - likely have an etiologic role in the pathogenesis of this condition in chronic lymphocytic leukemia patients. In addition, recruitment of eosinophils to the skin may occur secondary to an immune shift toward a T helper 2 type response, possibly caused by the neoplastic cells, that results in these T cells producing interleukin 4. Clinical observations, currently based on the prompt (within four weeks) and sustained (at least 12 weeks to 6 months) resolution of He Remained in two elderly men with He Remained, suggests that dupilumab may be the treatment of choice in chronic lymphocytic leukemia patients with this condition.