Bleomycin-induced flagellate hyperpigmentation

Abstract

Bleomycin is a chemotherapeutic agent used in the treatment of different tumours. It has several side effects, including flagellate hyperpigmentation, which is a unique and a well-documented side effect of bleomycin therapy. We report a case of a 23-year-old woman with a personal history of ovarian dysgerminoma, who developed flagellate hyperpigmentation on trunk after bleomycin therapy.

A Danish case of bleomycin‐induced flagellate erythema

“…The development of the condition appears to be independent of the dose and mode of administration, 4 and severe cases may require discontinuation of bleomycin, since no specific treatment has been identified 1,6 . However, as shown in the present case, it may be possible to continue the treatment with bleomycin with supportive therapy of antihistamines, topical, and oral corticosteroids 7‐9 . In most cases, complete remission of BIFE was reported months after discontinuation of bleomycin, while the present case and several others showed some degree of persistent hyperpigmentation up to 1 year after the treatment 10 .…”

“…1,6 However, as shown in the present case, it may be possible to continue the treatment with bleomycin with supportive therapy of antihistamines, topical, and oral corticosteroids. [7][8][9] In most cases, complete remission of BIFE was reported months after discontinuation of bleomycin, while the present case and several others showed some degree of persistent hyperpigmentation up to 1 year after the treatment. 10 Patients who are undergoing treatment with bleomycin and present symptoms of cutaneous prurigo or rash should be suspected of BIFE.…”

Utilizing Cohesive Bandage to Prevent Adverse Effects of Bleomycin Sclerotherapy: A Case Report

“…One hypothesis of the dermal accumulation of bleomycin is secondary to a decreased presence in the skin of bleomycin hydrolase, which breaks down bleomycin, but the exact mechanisms are not fully understood. 4,5 Specific treatment for flagellate dermatitis is currently unavailable. 10 When hyperpigmentation issues occur, they commonly resolve within 4 months, with cessation of bleomycin treatment; however, hyperpigmentation has been noted to be present up to 3 years after initial presentation.…”

“…[1][2][3] The metabolism of bleomycin by bleomycin hydrolase is lessened in the skin and lungs, which causes the accumulation of bleomycin, leading to the adverse effects seen most in these 2 tissues. 4,5 The cause of the hyperpigmentation is unknown, but 1 hypothesis is bleomycin leaking out of the blood vessels, after systemic absorption, from microtrauma. 5 Hyperpigmentation usually appears 1 day to 9 weeks after bleomycin administration and often resolves within 4 months, but prolonged hyperpigmentation lasting more than 3 years has been reported.…”

“…4,5 The cause of the hyperpigmentation is unknown, but 1 hypothesis is bleomycin leaking out of the blood vessels, after systemic absorption, from microtrauma. 5 Hyperpigmentation usually appears 1 day to 9 weeks after bleomycin administration and often resolves within 4 months, but prolonged hyperpigmentation lasting more than 3 years has been reported. 4,5 Bleomycin toxicity can also present as Raynaud phenomenon, hyperkeratosis, palmoplantar desquamation, and nailbed changes.…”