A case of bleomycin-induced flagellate dermatitis: A case report

Abstract

The article description and significance to dermatologists: bleomycin flagellate dermatitis is a rare cutaneous manifestation, believed to be due to the lack of bleomycin hydrolase enzyme in the skin, which inactivates bleomycin, resulting in its accumulation. This is thought to be a dose-dependent reaction, and doses over 200 U and higher may increase risk. This case describes a male developing a pruritic, erythematous linear flagellated dermatitis to the lower back after his third cycle of bleomycin, etoposide and cisplatin for a stage 3 seminoma. Pruritis resolved and erythema improved with the treatment of bilastine and desoximetasone cream. It is important to recognize this condition because untreated pruritis may lead to increased impairment of the skin barrier in already immunocompromised patient populations. This may also give further evidence to having ongoing and continuing collaboration between Dermatology and Medical Oncology for any patients presenting with a new rash undergoing chemotherapy treatments.

Flagellate dermatitis in bleomycin chemotherapy: a causality?

“…11 Bleomycin damages endothelial cells by upregulating TGF-β (tumour necrosis factor beta), triggering keratinocyte death, and causing a cytotoxic effect on melanocytes, among other mechanisms for cutaneous inflammation and pigmentation. 9 Bleomycin-induced flagellate dermatitis is a dose-dependent reaction that usually occurs with cumulative doses above 200 IU. 8 However, there are several case reports indicting otherwise.…”

“… 11 Bleomycin damages endothelial cells by upregulating TGF- β (tumour necrosis factor beta), triggering keratinocyte death, and causing a cytotoxic effect on melanocytes, among other mechanisms for cutaneous inflammation and pigmentation. 9 …”

“…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…”

“…Furthermore, the pruritus that is caused by these alterations may trigger excoriations, resulting in abrasions and microtrauma, which can lead to vasodilation and increased bleomycin deposition 11. Bleomycin damages endothelial cells by upregulating TGF- β (tumour necrosis factor beta), triggering keratinocyte death, and causing a cytotoxic effect on melanocytes, among other mechanisms for cutaneous inflammation and pigmentation 9…”

“…The differential diagnosis of flagellate erythema includes bleomycin flagellate dermatitis, shiitake mushroom intake, dermatomyositis, adult-onset Still’s disease and dermatitis artefacta 8 9. Skin manifestations which appear following bleomycin administration and hyperpigmentation which occurs after drug suspension are associated with bleomycin-induced skin disorders.…”