Bleomycin-Induced Flagellate Dermatitis

A Danish case of bleomycin‐induced flagellate erythema

“…BIFE is a cutaneous side effect to treatment with bleomycin among several others, including Raynaud's phenomenon, gangrene, fibrosis, alopecia, edema, nail changes, and neutrophilic eccrine hidradenitis (NEH) 5 . The development of the condition appears to be independent of the dose and mode of administration, 4 and severe cases may require discontinuation of bleomycin, since no specific treatment has been identified 1,6 . However, as shown in the present case, it may be possible to continue the treatment with bleomycin with supportive therapy of antihistamines, topical, and oral corticosteroids 7‐9 .…”

“…Flagellate erythema is characterized by pruritic linear infiltrated erythematous lesions, arranged in flagellate patterns. It is known to be associated with ingestion of shiitake mushrooms, dermatomyositis, adult‐onset Still's disease, and treatment with antineoplastic agents such as bleomycin 1 . Although bleomycin‐induced flagellate erythema (BIFE) is a well‐described condition in the literature, it is rarely seen in clinical practice 2 .…”

Flagellate dermatitis in bleomycin chemotherapy: a causality?

“…Various other case reports have also mentioned the occurrence of flagellate dermatitis after the administration of bleomycin (table 1). 1 2 4 6 8 9 11…”

“… 1 While flagellate dermatitis is most commonly linked to bleomycin, it can also be caused by the chemotherapy agents peplomycin and docetaxel as well as shiitake mushroom toxin, and is sometimes found on patients with dermatomyositis. 6 7 This paper describes two cases of flagellate dermatitis, one in a patient with germ cell carcinoma and another in a patient with osteosarcoma who were both diagnosed with flagellate dermatitis after the administration of bleomycin. The aim of this paper is to provide an overview of how this unique toxic reaction to bleomycin manifests on the skin so that clinicians can take it into consideration when administering this chemotherapy drug.…”

“…The term ‘flagellate’ is derived from the Latin word ‘flagellum’, which means a whip-like appearance 1. While flagellate dermatitis is most commonly linked to bleomycin, it can also be caused by the chemotherapy agents peplomycin and docetaxel as well as shiitake mushroom toxin, and is sometimes found on patients with dermatomyositis 6 7. This paper describes two cases of flagellate dermatitis, one in a patient with germ cell carcinoma and another in a patient with osteosarcoma who were both diagnosed with flagellate dermatitis after the administration of bleomycin.…”