Bleomycin and the skin

Yamamoto, Toshiyuki

doi:10.1111/j.1365-2133.2006.07474.x

Cited by 121 publications

(116 citation statements)

References 99 publications

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“…The recommended dosage starts at 0.1 ml (1.5 IU/ml) and can go up to a maximum dose of 6 ml in order to prevent adverse effects which are usually cutaneous and less common pulmonary. 31,32 For patients with old scars that do not respond to intralesional steroid, the recommended treatment is between 2 and 6 sessions per month. Bleomycin usage is still uncommon in the clinical practice.…”

Section: Bleomycinmentioning

confidence: 99%

Novel Insights on Understanding of Keloid Scar: Article Review

Mari

Alsabri

Tabal

et al. 2015

Journal of the American College of Clinical Wound Specialists

123

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Keloid scar, dermal benign fibro-proliferative growth that extends outside the original wound and invades adjacent dermal tissue due to extensive production of extracellular matrix, especially collagen, which caused by over expression of cytokines and growth factors. Although many attempts were made to understand the exact pathophysiology and the molecular abnormalities, the pathogenesis of keloid scar is yet to be determined. Even though there are several treatment options for keloid scars include combination of medical and surgical therapies like combination of surgical removal followed by cryotherapy or intralesional steroid therapy, the reoccurrence rate is still high despite the present treatment. In this review, PubMed, clinical key and Wright State Library web site have been used to investigate any update regarding Keloid disease. We used Keloid, scar formation, hypertrophic scar and collagen as key words. More than 40 articles have been reviewed. This paper reviews literature about keloid scar formation mechanism, the most recent therapeutic options including the ones under research.

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Section: Bleomycinmentioning

confidence: 99%

Novel Insights on Understanding of Keloid Scar: Article Review

Mari

Alsabri

Tabal

et al. 2015

Journal of the American College of Clinical Wound Specialists

123

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“…[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.…”

Section: Resultsmentioning

confidence: 99%

“…2 It is widely used to treat a variety of malignancies and warts, and it is used in chemical pleurodesis. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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. 3,4 Many patients present with urticarial rash and generalized pruritus, which ameliorates spontaneously when the lesions develop into their striking hyperpigmentationlike lesions.…”

Section: Discussionmentioning

confidence: 99%

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

Hao

Mahmoud

2017

TPJ

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A 31-year-old man underwent left radical orchiectomy at our hospital for a growing left testicular mass. Pathology revealed a mature teratoma. Computed tomography scan of his abdomen and pelvis obtained in the following month revealed periaortic and pericaval adenopathy, with the largest nodal mass measuring 1.5 cm. Serum alphafetoprotein level was persistently elevated at 336.7 ng/mL (normal ≤ 9 ng/mL). Three months after surgery, our patient completed 3 cycles of bleomycin, etoposide, and cisplatin chemotherapy. During a follow-up visit a month later, physical examination revealed a painless, nonpruritic, linear hyperpigmentation on the patient's trunk (Figure 1). Six months after the skin pigmentation first appeared, our patient continued to have the hyperpigmentation and remained otherwise asymptomatic. DISCUSSIONFlagellate dermatitis or hyperpigmentation has been reported in the setting of bleomycin therapy. 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. 3,4 Many patients present with urticarial rash and generalized pruritus, which ameliorates spontaneously when the lesions develop into their striking hyperpigmentationlike lesions. 3,4 Our patient did not report any pain or itching. The pathogenesis of bleomycin-induced skin lesions is not clear, but a hypothesis is skin reaction to localized toxic levels of bleomycin. 3,4 Bleomycin is an antitumor antibiotic that was isolated from a strain of Streptomyces verticillus. 2 It is widely used to treat a variety of malignancies and warts, and it is used in chemical pleurodesis. 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. 1,5 CONCLUSIONBleomycin-induced skin lesions are usually self-limited and resolve within several weeks to months as long as bleomycin is avoided, although permanent hyperpigmentation in affected areas is not unusual. [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. The image in Figure 1 is memorable and will benefit all clinicians or practitioner...

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“…2,33 The pathogenesis of scleroderma involves a complex interplay between vascular damage, inflammation, and fibrosis; however, the detailed mechanisms remain to be determined. 2,25,44 It has been suggested that factors released from inflammatory cells in the early stages lead to the formation of myofibroblasts capable of producing collagens, resulting in fibrosis. 15,17,21,27,45 In particular, macrophages are thought to act as important cells for the onset of scleroderma.…”

mentioning

confidence: 99%

Immunophenotypical Characterization of Macrophages in Rat Bleomycin-Induced Scleroderma

et al. 2012

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Scleroderma is a skin disorder characterized by persistent fibrosis. Macrophage properties influencing cutaneous fibrogenesis remain to be fully elucidated. In this rat (F344 rats) model of scleroderma, at 1, 2, 3, and 4 weeks after initiation of daily subcutaneous injections of bleomycin (BLM; 100 ml of 1 mg/ml daily), skin samples were collected for histological and immunohistochemical evaluations. Immunohistochemically, the numbers of cells reacting to ED1 (anti-CD68; phagocytic activity) and ED2 (anti-CD163; inflammatory factor production) began to increase at week 1, peaked at week 2, and decreased thereafter. In contrast, the increased number of cells reacting to OX6 (anti-MHC class II molecules) was seen from week 2 and remained elevated until week 4. aSmooth muscle actin-positive myofibroblasts were increased for 4 weeks. Double labeling revealed that galectin-3, a regulator of fibrogenic factor TGF-b1, was expressed in CD68þ, CD163þ, and MHC class IIþ macrophages and myofibroblasts. mRNA expression of TGF-b1, as well as MCP-1 and CSF-1 (both macrophage function modulators), were significantly elevated at weeks 1 to 4. This study shows that the increased number of macrophages with heterogeneous immunophenotypes, which might be induced by MCP-1 and CSF-1, could participate in the sclerotic lesion formation, presumably through increased fibrogenic factors such as galectin-3 and TGF-b1; the data may provide useful information to understand the pathogenesis of the human scleroderma condition.

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Bleomycin and the skin

Cited by 121 publications

References 99 publications

Novel Insights on Understanding of Keloid Scar: Article Review

Novel Insights on Understanding of Keloid Scar: Article Review

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

Immunophenotypical Characterization of Macrophages in Rat Bleomycin-Induced Scleroderma

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