Bleomycin-Induced Flagellate Erythema in a Patient Diagnosed with Ovarian Yolk Sac Tumor

Boussios, Stergios; Moschetta, Michele; McLachlan, Jennifer; Banerjee, Susana

doi:10.1155/2015/574708

Cited by 8 publications

(13 citation statements)

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“…Flagellate erythema is a rare side effect of bleomycin and its mechanism is not completely understood. It is hypothesized that scratching plays a role, causing local vasodilatation and bleomycin accumulation . Although generalized pruritus seems to precede the majority of cases, there are reports of nonpruritic lesions .…”

Section: Discussionmentioning

confidence: 99%

“…It is hypothesized that scratching plays a role, causing local vasodilatation and bleomycin accumulation. 8 Although generalized pruritus seems to precede the majority of cases, there are reports of nonpruritic lesions. 3 There is no characteristic distribution of the lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Usually erythema has a self-limited course of several weeks to months, although permanent hyperpigmentation in affected areas may develop as the rash resolves. 8 This rash may appear regardless of the route of administration of bleomycin: intravenous, intramuscular, topical, or even intrapleural. 1 Although usually considered a dose-dependent reaction, flagellate erythema may also be an idiosyncratic reaction to low-dose bleomycin.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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

Pinto

Lorca-García

Berenguer

et al. 2017

Pediatric Dermatology

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pinto

Lorca-García

Berenguer

et al. 2017

Pediatric Dermatology

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“…[ 4 ] Flagellate erythema as a cutaneous manifestation of bleomycin therapy was first described in 1970. [ 6 ] The exact pathogenesis of bleomycin-induced flagellate dermatitis is still unknown and different other theories have been proposed for the same like micro-trauma, inflammatory oncotaxis, increased melanogenesis, heat recall, and reduced epidermal turnover allowing prolonged melanocytes – keratinocyte contact. [ 4 ] It is usually dose dependent and a reaction as a result of bleomycin irrespective of the route of administration or malignancy being treated and usually occurs after a cumulative dose of 90–285 mg, but some cases have been reported with doses as low as 15 mg given parenterally.…”

Section: Discussionmentioning

confidence: 99%

Flagellate rash: An unusual complication of bleomycin therapy – A case report with brief review of literature

Agrawal

Talwar

Saini

et al. 2017

Indian J Med Paediatr Oncol

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Chemotherapy-induced skin rashes are common toxicities encountered which require careful assessment and evaluation as rashes could be a manifestation of primary malignancy itself and a variety of drugs used in combination further complicate the clinical scenario. Bleomycin is an anticancer antibiotic derived from Streptomyces verticillus and has been commonly used in the treatment of Hodgkin's disease, germ cell tumors and for pleurodesis. There are various dermatological adverse effects of bleomycin which have been previously reported in literature including skin peeling, hyperkeratosis, nail bed changes, Raynaud's phenomenon, and palmoplantar desquamation. Bleomycin-induced skin rashes are seen infrequently now a day due to its declining use in clinical practice. We report here a 29-year-old male with Stage III germ cell tumor who developed widespread flagellate rash after receiving 3 cycles of bleomycin-based chemotherapy which responded to treatment with local steroids and omission of bleomycin from further chemotherapy cycles.

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Bleomycin

2016

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Bleomycin Flagellate erythema: case reportA 20-year-old woman developed flagellate erythema during therapy with bleomycin [route not stated].The woman underwent fertility-preserving ovarian cancer resection with left oophorectomy. Subsequently, she received 4 cycles of 5-day schedule BEP regimen, which included bleomycin 30000IU on days 1, 8, and 15, etoposide and cisplatin. Four months after the initiation of chemotherapy, she noticed a dark streaked rash affecting her chest and the upper part of the dorsum. Dermatological evaluation showed an extensive violaceous and erythematous excoriated rash with a striking linear configuration and a postinflammatory hyperpigmentation.The woman's lesions resolved completely 6 months after the withdrawal of bleomycin.Author comment: "An additional proposed mechanism for bleomycin-induced flagellate hyperpigmentation includes stimulation of melanocytes by adrenocorticotrophic hormone." Boussios S, et al. Bleomycin-induced flagellate erythema in a patient diagnosed with ovarian yolk sac tumor. Case Reports in Oncological Medicine 2015: 2015. Available from: URL: http://doi.org/10.

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Bleomycin-Induced Flagellate Erythema in a Patient Diagnosed with Ovarian Yolk Sac Tumor

Abstract: Flagellate linear hyperpigmentation can rarely be caused by the chemotherapy agent, bleomycin. Herein, we describe the case of a 20-year-old woman treated with bleomycin for an ovarian yolk sac tumor and review the prominent features of this form of dermatitis.

Cited by 8 publications

References 8 publications

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

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

Flagellate rash: An unusual complication of bleomycin therapy – A case report with brief review of literature

Bleomycin

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