Bleomycin-induced flagellate erythema: A case report and review of the literature

Lee, Hui‐Young; Lim, Ki Moo; Ryu, Young-Joon; Song, Seo‐Young

doi:10.3892/ol.2014.2179

Cited by 24 publications

(35 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We should stress that none of our patients presenting reticulate hyperpigmentation were treated with bleomycin. Moreover, whip-like striated lesions observed with bleomycin usually develop in a well-demarcated linear configuration and are most often papular and larger [17,18,20]. Flagellate dermatitis also mainly involves the back and pressure areas, but the lesions are generally more self-limiting and preceding pruritic erythematous linear streaks, sometimes severe, are much more frequently noted in comparison with reticulate hyperpigmentation [15,17,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…However, histopathological changes are not uniform and a broad spectrum of histological features has been reported, including perivascular or perisudoral lymphoeosinophilic cell infiltration, hyperkeratosis with focal parakeratosis and spongiosis [15,16,17]. Pathophysiological mechanisms leading to flagellate hyperpigmentation are still unknown, but a local toxic effect after drug leakage within the skin or a reduced epidermal turnover with prolonged contact between melanocytes and keratinocytes have been postulated [15,17,20]. Finally, it has been hypothesized that bleomycin may persist longer in the skin due to a lower level of bleomycin hydrolase [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…More specific clinical presentations have been less frequently identified such as serpentine supravenous hyperpigmentation (mainly with 5-fluorouracil) [11,12,13,14] or bleomycin-induced flagellate hyperpigmentation [15,16,17,18,19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Chemotherapy-Related Reticulate Hyperpigmentation: A Case Series and Review of the Literature

Regnault

Gadaud²,

Boulinguez

et al. 2015

Dermatology

View full text Add to dashboard Cite

Background: Inherited or acquired reticulate hyperpigmentation represents a heterogeneous group of infrequent dermatological conditions. The development of reticulate hyperpigmentation has so far been rarely reported to be associated with chemotherapeutic agents, including fluorouracil, bleomycin or a combination of cytarabine and idarubicin. Case Reports: We describe 5 cases of chemotherapy-related reticulate hyperpigmentation in patients treated with different chemotherapeutic regimens, in particular paclitaxel or cytarabine. The lesions were similar in all cases, with reticulate and/or linear hyperpigmented streaks, which were mainly located to the back and buttocks. Histology showed increased melanogenesis, which suggests a direct toxic effect of chemotherapy on melanocytes. Reflectance confocal microscopy was performed in 2 patients showing a similar pattern, with an increased amount of melanin in basal keratinocytes. These features have been compared with the available data through a literature review. Conclusion: Reticulate hyperpigmentation is an underestimated but characteristic complication of chemotherapy. Neither specific management nor discontinuation of the chemotherapeutic regimen is required.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chemotherapy-Related Reticulate Hyperpigmentation: A Case Series and Review of the Literature

Regnault

Gadaud²,

Boulinguez

et al. 2015

Dermatology

View full text Add to dashboard Cite

show abstract

“…Usually erythema has a self‐limited course of several weeks to months, although permanent hyperpigmentation in affected areas may develop as the rash resolves . This rash may appear regardless of the route of administration of bleomycin: intravenous, intramuscular, topical, or even intrapleural …”

Section: Discussionmentioning

confidence: 99%

Bleomycin‐induced flagellate erythema after venous malformation sclerosis—Case report and brief review

Pinto

Lorca-García

Berenguer

et al. 2017

Pediatric Dermatology

View full text Add to dashboard Cite

Bleomycin-induced flagellate erythema is a rare but typical skin toxicity of bleomycin. We report the case of a boy with a left foot venous malformation who developed this skin rash after two sessions of bleomycin intralesional injection. We discuss the mechanism and characteristics of this reaction to bleomycin, which is usually benign and self-limited. We conclude that, although rare, flagellate pigmentation can occur when bleomycin is used as a sclerosant in children.Bleomycin is an antibiotic with cytotoxic properties, commonly used in combination regimens for the treatment of Hodgkin's and non-Hodgkin's lymphoma; squamous cell carcinoma of the head and neck; and germ cell, gynecologic, and skin tumors.1 In addition to its antitumor activity, bleomycin is used as a sclerosant in the treatment of vascular malformations and in recurrent malignant pleural effusions.1 Bleomycin-induced toxicities are more common in the lungs and skin because of a lower activity of bleomycin hydrolase in these organs. 2The reported dermatologic side effects of bleomycin include alopecia, Raynaud's syndrome, hyperkeratosis, nail bed changes, palmar and plantar desquamation, eczematous changes, digital gangrene, and pigmentary alterations. 3,4 Less commonly, skin toxicity presents as flagellate erythema, a unique drug rash that appears as "whiplike" linear streaks. It may affect the face, trunk, or limbs. 5Moulin first described it in 1970. 6Although the use of bleomycin as an antineoplastic agent has been decreasing, 5 there has been growing interest in its use as a sclerosant because of the low risk of side effects and its low cost. In addition, patients recover quickly, with good outcomes. 7We report a case of bleomycin-associated flagellate erythema after intralesional injection of a venous malformation and discuss the mechanism and characteristics of this reaction. | CASE REPOR TWe report the case of a 14-year-old boy with a venous malformation (VM) in the left lower limb. He underwent partial excision of the lesion at the age of 9 years. The postoperative period was complicated by a hematoma and skin ulceration, which was managed using local wound care. There was no other significant past medical or surgical history and no dermatologic disorders or allergies. A skin biopsy of a lesion on his left flank was obtained. Pathologic examination showed lymphocytic and histiocytic infiltration around

show abstract

“…Bleomycin toxicity involves the skin and lungs. Cutaneous complications include hyperpigmentation, Raynaud's phenomenon, and flagellate erythema . These typically occur at cumulative doses greater than 100 units but have also been reported at lower doses .…”

Section: Methodsmentioning

confidence: 99%

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration

et al. 2016

View full text Add to dashboard Cite

show abstract

Bleomycin-induced flagellate erythema: A case report and review of the literature

Cited by 24 publications

References 15 publications

Chemotherapy-Related Reticulate Hyperpigmentation: A Case Series and Review of the Literature

Chemotherapy-Related Reticulate Hyperpigmentation: A Case Series and Review of the Literature

Bleomycin‐induced flagellate erythema after venous malformation sclerosis—Case report and brief review

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration

Contact Info

Product

Resources

About