Bleomycin-Induced Flagellate Erythema

Chen, Yi Bin; Rahemtullah, Aliyah; Breeden, Eric; Hochberg, Ephraim P.

doi:10.1200/jco.2006.09.7691

Cited by 44 publications

(95 citation statements)

References 8 publications

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“…The linear or streaked pigmentation usually develops after a cumulative dose between 100-300 U of bleomycin (6,17), whereas considering our cases the cumulative doses were 38 U and 30 U. There are only 17 adult cases of FH following treatment with low-dose bleomycin (Table 1) (2,4,6,8,9,14,15,(17)(18)(19)(20)(21)(22)(25)(26)(27). It is observed that the majority of patients developing FH within 7 days of administration of bleomycin were young adults, even the dose of bleomycin was between 5-30 U.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis is based on the characteristic clinical appearance of skin lesions. Lesions are usually seen on the upper trunk and limbs and may be associated with pruritus (2,4,6). It can be said that hyperpigmented streaks are generally localized on areas of pressure in linear, or streaked (7).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

“…It occurs in 8-20% of the patients undergone bleomycin treatment, and its mechanism of causing the complication stands unknown (2). Mostly, the complication is considered to happen dose-dependent and generally occurs when the cumulative dose is between 100 and 300 U (3).…”

Section: Introductionmentioning

confidence: 99%

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

Cokmert¹,

Demir²,

Akyol³

2015

Acta Oncol Tur.

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ÖZETBleomisin'in mukokutanöz yan etkileri, 100 U'den daha yüksek kümülatif dozları alan hastalarda yaygındır. Flagella benzeri hiperpigmentasyon bleomisin kullanımının neden olduğu, vakaların yaklaşık % 8-20'sinde görülen ilginç bir cilt reaksiyonudur. Mekanizması bilinmemektedir. Tanı karakteristik klinik görünüme dayanmaktadır. Hiperpigmente cilt lezyonlarının histolojik incelemesi, bazal keratinositlerde artmış melanin içeriğini ortaya koymaktadır. Hafif vakalar antihistaminiklere ve/veya sistemik steroide yanıt verir fakat birçok vakada ilacın kesilmesi gerekebilir. Biz rölatif olarak daha düşük (kümülatif dozlar 30 ve 38 U) dozlarla bleomisin kaynaklı flagella benzeri hiperpigmentasyonu olan 2 vaka sunuyoruz. Bleomisin kullanan hastalarda hiç de nadir olmayan bu komplikasyonu klinisyenler akılda bulundurmalıdırlar. Anahtar Kelimeler: Hiperpigmentasyon, Bileomisin, Cilt ABSTRACT Mucocutaneus side effects of bleomycin therapy are common in patients receiving cumulative doses greater than 100 U (100 mg). Flagellate hyperpigmentation is an interesting cutaneus reaction caused by bleomycin use, and is seen in about 8-20% of cases. The mechanism is unknown. Diagnosis is based on its characteristic clinical appearance. Histological examination of hyperpigmented skin lesions has demonstrated increased melanin content in basal keratinocytes. It has been suggested that mild cases may respond to antihistamines and ⁄ or systemic steroids, but in many cases discontinuation of the drug may be necessary. We present two patients (cumulative doses of 30 and 38 U) that developed bleomycin-induced flagellate hyperpigmentation with relatively low doses. Because the condition is not uncommon in patients who are using this drug, the clinician should be mindful of this complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Cokmert¹,

Demir²,

Akyol³

2015

Acta Oncol Tur.

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Flagellate Mushroom Dermatitis

Young

Elgash

2022

JAMA Dermatol

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A woman in her 50s presented with a 4-day history of a diffuse, progressive, and pruritic rash. She had no known allergies and did not take any medications. She had no exposures to chemicals, detergents, or new personal care products; however, the patient consumed raw shiitake mushrooms several days before symptom onset. An examination revealed dozens of long flagellate streaks composed of red papules distributed across the trunk and extremities (Figure). She denied fever, malaise, or dyspnea. Laboratory results were remarkable for eosinophilia. The findings and history were consistent with flagellate mushroom dermatitis. The patient was treated with topical steroids, oral antihistamines, and raw shiitake mushroom avoidance, and the condition improved without sequelae.Flagellate mushroom dermatitis, also known as shiitake mushroom dermatitis, is thought to be caused by lentinan, a thermolabile toxin in shiitake mushrooms (Lentinula edodes). 1 Proposed pathogenesis includes delayed T-cell-mediated and toxinmediated reactions, as lentinan has T-cell-mediated antitumor properties, inducing vasodilation and hemorrhage reactions that can manifest as skin findings. However, the exact mechanism remains unknown. 2,3 Characteristic linear streaks of small erythematous pruritic papules appear 1 to 2 days following raw mushroom ingestion. It has been hypothesized that the linear pattern is partially produced by scratching; however, this has been disputed, as there are documented cases in which this pattern appears in the absence of scratching. 4 The distribution is commonly on the trunk and extremities. 1 The differential diagnosis for these findings is narrow and includes adult-onset Still disease, dermatomyositis, and flagellate erythema from chemotherapeutic agents, such as bleomycin. 3,4 Diagnosis of flagellate dermatitis is based on history and physical examination findings. Histology results are often nonspecific and may show spongiosis, perivascular lymphocytic and neutrophilic infiltrate, or eosinophils. 1,3 Flagellate mushroom dermatitis is self-limited, although treatment with topical steroids and oral antihistamines can be helpful. Resolution typically occurs within 1 to 8 weeks of mushroom avoidance, and thoroughly cooking mushrooms can prevent this dermatitis. Recognition of this condition may help guide patients to avoid triggers and minimize unnecessary testing.

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Current awareness: Pharmacoepidemiology and drug safety

2007

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Bleomycin-Induced Flagellate Erythema

Cited by 44 publications

References 8 publications

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

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

Flagellate Mushroom Dermatitis

Current awareness: Pharmacoepidemiology and drug safety

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