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Diagnosis: Bleomycin-induced flagellate hyperpigmentation
Bleomycin is an antineoplastic agent. Most reported side effects involve the lung and skin since these organs have lower concentrations of the enzyme that detoxifies bleomycin. Other dermatologic side effects of bleomycin include Raynaud's phenomenon, hyperkeratosis, nailbed changes, and peeling of the skin on the palmar and plantar surfaces.
Flagellate erythema has been described in relation to bleomycin treatment along with other reported associations with peplomycin (a bleomycin derivative), docetaxel, dermatomyositis, adult-onset Still's disease, and shiitake mushroom dermatitis. The rash may appear following administration of bleomycin by any route and has been shown to be dose independent. Onset occurs anytime from 1 day to several months after exposure to the offending agent. Patients typically present with history of itching followed by the appearance of red linear streaks, which are most commonly found on the trunk. Over time, the erythema will resolve to postinflammatory hyperpigmentation.
The exact cause is unknown, but it is thought that scratching causes vasodilation with bleomycin accumulating in the skin. Diagnosis is made by physical examination of the characteristic appearance of the rash along with the history of chemotherapy. A skin biopsy may be performed. In most cases, the rash resolves spontaneously within 6-8 months. Severe rashes may warrant discontinuation of bleomycin. Using antihistamines and topical and oral corticosteroids in conjunction with bleomycin may reduce the incidence of flagellate erythema/hyperpigmentation.
Diagnosis: Bleomycin-induced flagellate hyperpigmentation
Bleomycin is an antineoplastic agent. Most reported side effects involve the lung and skin since these organs have lower concentrations of the enzyme that detoxifies bleomycin. Other dermatologic side effects of bleomycin include Raynaud's phenomenon, hyperkeratosis, nailbed changes, and peeling of the skin on the palmar and plantar surfaces.
Flagellate erythema has been described in relation to bleomycin treatment along with other reported associations with peplomycin (a bleomycin derivative), docetaxel, dermatomyositis, adult-onset Still's disease, and shiitake mushroom dermatitis. The rash may appear following administration of bleomycin by any route and has been shown to be dose independent. Onset occurs anytime from 1 day to several months after exposure to the offending agent. Patients typically present with history of itching followed by the appearance of red linear streaks, which are most commonly found on the trunk. Over time, the erythema will resolve to postinflammatory hyperpigmentation.
The exact cause is unknown, but it is thought that scratching causes vasodilation with bleomycin accumulating in the skin. Diagnosis is made by physical examination of the characteristic appearance of the rash along with the history of chemotherapy. A skin biopsy may be performed. In most cases, the rash resolves spontaneously within 6-8 months. Severe rashes may warrant discontinuation of bleomycin. Using antihistamines and topical and oral corticosteroids in conjunction with bleomycin may reduce the incidence of flagellate erythema/hyperpigmentation.
Diagnosis: Bleomycin-induced flagellate hyperpigmentation
Bleomycin is an antineoplastic agent. Most reported side effects involve the lung and skin since these organs have lower concentrations of the enzyme that detoxifies bleomycin. Other dermatologic side effects of bleomycin include Raynaud's phenomenon, hyperkeratosis, nailbed changes, and peeling of the skin on the palmar and plantar surfaces.
Flagellate erythema has been described in relation to bleomycin treatment along with other reported associations with peplomycin (a bleomycin derivative), docetaxel, dermatomyositis, adult-onset Still's disease, and shiitake mushroom dermatitis. The rash may appear following administration of bleomycin by any route and has been shown to be dose independent. Onset occurs anytime from 1 day to several months after exposure to the offending agent. Patients typically present with history of itching followed by the appearance of red linear streaks, which are most commonly found on the trunk. Over time, the erythema will resolve to postinflammatory hyperpigmentation.
The exact cause is unknown, but it is thought that scratching causes vasodilation with bleomycin accumulating in the skin. Diagnosis is made by physical examination of the characteristic appearance of the rash along with the history of chemotherapy. A skin biopsy may be performed. In most cases, the rash resolves spontaneously within 6-8 months. Severe rashes may warrant discontinuation of bleomycin. Using antihistamines and topical and oral corticosteroids in conjunction with bleomycin may reduce the incidence of flagellate erythema/hyperpigmentation.
This case and photo were submitted by Dr. Damon McClain, a dermatologist in Camp Lejeune, N.C., and by Parteek Singla. A 26-year-old male presented with asymptomatic hyperpigmented streaks on his back. He was receiving chemotherapy for testicular cancer. He received dexamethasone with his first chemotherapy treatment and had no cutaneous eruption at that time. He was not given a steroid with his second dose of chemotherapy. The lesions began an hour after that dose. Initially, the lesions were red and pruritic, and then they turned brown. The patient had no nailfold changes on examination. He had no other medical problems and reported that he had not eaten any unusual foods.
