Bleomycin-induced flagellate dermatitis

Abstract

Flagellate dermatitis shows very characteristic lesions: linear erythema or hyperpigmentation in various areas of the skin. It is a side effect of bleomycin, an immunosupressive drug used for several types of cancers. All physicians must be aware of this disease so they can make a rapid diagnosis and interrupt the causative agent. Our patient presented during chemotherapy for a Hodgkin's lymphoma pruritic, erythematous lesions on the lower limbs and the back diagnosed as flagellate dermatitis due to bleomycin.

Image Diagnosis: A Striking Bleomycin-Induced Skin Toxicity: Flagellate Hyperpigmentation

“…[1][2][3][4] The striking bleomycin-induced skin hyperpigmentation, as in our case, needs to be expected, and oncologists should discuss this adverse event with their patients before treatment. Primary care physicians should also be aware of this reaction because these patients may present for routine examinations.…”

“…2 Bleomycinrelated dermatologic toxicities include alopecia, skin ulceration (predominantly plantar-palmar), eczematous changes, erythematous bullae, sclerodermoid lesions, nail-bed changes, Raynaud phenomenon, painful inflammatory nodules on the fingers, warty hyperkeratotic plaques on the knees and elbows, digital gangrene, blisters, infiltrated violaceous plaques, and flagellate dermatitis. 1,2,5 Other side effects include pneumonitis that may lead to lung fibrosis, which is an absolute indication to stop bleomycin therapy. Bleomycin may cause nausea, vomiting, fatigue, and stomatitis.…”

“…1 The term "flagellate" is derived from the Latin flagellum, referring to the characteristic whip-like appearance of the dermatitis. 1 The rate of flagellate hyperpigmentation in patients who are treated with bleomycin may be as high as 20%. 2 Onset of bleomycin-induced skin lesions can vary from 1 day to 2 months after bleomycin administration.…”

Flagellate Hyperpigmentation Following Treatment with Low-Dose Bleomycine: Report of two cases

“…Fifty percent of bleomycin is inactivated by an aminohydrolase. Bleomycin-induced toxicity predominantly affects the lungs and skin due to the low levels of hydrolase in these tissues (2)(3)(4)(5). Mucocutaneous side effects of bleomycin are common, and include stomatitis, ulcers, erythematous and bullous lesions, sclerosis, nail changes, digital gangrene, Raynaud's phenomenon, and hyperkeratosis (5,6).…”

“…Bleomycin is an antineoplastic antibiotic, isolated from Streptomyces verticillus (1,2,3). It is widely used in the treatment of malignancies such as lymphomas, germ cell tumors, and squamous cell carcinoma (4).…”