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Gammopathic dermopathy: characterization of cutaneous MGUS
Emily R Gordon1, Caroline Chen1, Megan H Trager2
1Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Abstract:
Monoclonal Gammopathy of Undetermined Significance (MGUS) is a clonal plasma cell disorder that is considered preneoplastic, asymptomatic, and only requiring observation. However, MGUS may result in cutaneous complications, which are poorly understood, causing treatment delays and patient suffering. We present 30 patients with cutaneous findings associated with MGUS, characterizing clinical presentations, isoforms, treatments, and outcomes. These included: MGUS-associated 'rashes' (pruritic eczematous rashes), reactive and mucin-depositional conditions (pyoderma gangrenosum, scleromyxedema), M-protein-related deposition disorders (POEMS syndrome, Waldenstrom macroglobulinemia), and cutaneous lymphomas. Twelve of 30 (40%) patients received multiple myeloma drugs (MMDs). Eleven (92%) patients improved, and those not receiving MMDs rarely improved, suggesting that MMDs have efficacy for cutaneous manifestations of MGUS. Therefore, trialing MMDs may be warranted for patients with MGUS not responding to other therapies. Moreover, evaluation for monoclonal gammopathy in elderly patients with intractable pruritus or other chronic skin conditions that are non-responsive to skin-directed therapies should be considered.
Insights
Monoclonal Gammopathy of Undetermined Significance (MGUS) can cause skin issues. Multiple myeloma drugs effectively treated these cutaneous manifestations in 92% of patients, suggesting their therapeutic potential.
Area of Science:
- Dermatology
- Hematology
- Oncology
Background:
- Monoclonal Gammopathy of Undetermined Significance (MGUS) is a preneoplastic, asymptomatic plasma cell disorder.
- Cutaneous complications of MGUS are poorly understood, leading to treatment delays and patient distress.
Purpose of the Study:
- To characterize clinical presentations, treatments, and outcomes of cutaneous findings associated with MGUS.
- To evaluate the efficacy of multiple myeloma drugs (MMDs) for MGUS-related skin conditions.
Main Methods:
- Retrospective analysis of 30 patients with cutaneous findings and MGUS.
- Categorization of skin conditions including rashes, reactive conditions, deposition disorders, and lymphomas.
- Assessment of treatment responses, particularly to MMDs.
Main Results:
- Diverse cutaneous manifestations were observed, including pruritic eczematous rashes, pyoderma gangrenosum, scleromyxedema, POEMS syndrome, Waldenstrom macroglobulinemia, and cutaneous lymphomas.
- 40% of patients received MMDs, with 92% showing improvement.
- Patients not treated with MMDs rarely improved.
Conclusions:
- MMDs demonstrate significant efficacy for cutaneous manifestations of MGUS.
- MMDs may be warranted for refractory MGUS-related skin conditions.
- Consider screening for monoclonal gammopathy in elderly patients with non-responsive chronic skin conditions.
