Flagellate Dermatitis in a Child Most Likely Secondary to Doxorubicin

Abstract

Flagellate dermatitis, a cutaneous eruption in which the patient appears to have been whipped, has been described with antineoplastic agents and shiitake mushroom ingestion. A 15-year-old girl with metastatic Ewing sarcoma developed pruritic erythematous linear lesions on her trunk that became hyperpigmented over time during her first cycle of chemotherapy with doxorubicin, vincristine, cyclophosphamide, and ganitumab. Flagellate dermatitis was diagnosed based on clinical and histologic findings. Flagellate dermatitis (FD) is a rare cutaneous eruption named for its appearance, in which the patient appears to have been whipped. It has been associated with chemotherapeutic agents such as bleomycin . We report FD in a child that occurred during chemotherapy treatment that included doxorubicin.

Linear and confluent erythema over the extremities in an infant

“…It presents clinically as red, parallel, linear macules, coalescent papules, or purpuric lesions mostly on the back and the flanks. The etiological factors for flagellate dermatitis in children include chemotherapeutic agents such as bleomycin, doxorubicin, peplomycin and docetaxel, dermatomyositis, chikungunya, and parvovirus B19 infection 4‐7 . Flagellate marks on skin that have no obvious cause should raise the suspicion of child abuse.…”

Cutaneous reactions to pediatric cancer treatment: Part I. Conventional chemotherapy

“…In one report, a 15-year-old girl on combination chemotherapy (vincristine, doxorubicin, cyclophosphamide, and ganitumab) for Ewings sarcoma developed flagellate dermatitis, which was attributed to conventional doxorubicin. 45 Although liposomal doxorubicin is less commonly used in pediatrics, some reported cutaneous side effects include PPE ( Figure 2) and high-grade mucositis. 46 Doxorubicin has also been associated with onychodystrophy, mainly with development of Beau's lines.…”

Bleomycin-Induced Flagellate Dermatitis

“…Flagellate dermatitis, named for its distinctive whiplike pattern, is a rare cutaneous eruption that may be seen with ingestion of shiitake mushrooms, adult-onset Still disease, dermatomyositis, human immunodeficiency virus, and medications such as bleomycin, doxorubicin, peplomycin, docetaxel, cisplatin, trastuzumab, and bendamustine. [1][2][3] Bleomycin is the most common chemotherapeutic cause and is often associated with pruritus. Flagellate dermatitis has been called shiitake dermatitis because it can occur with shiitake mushroom ingestion, but it is usually nonpruritic in these cases.…”

“…Flagellate dermatitis has been called shiitake dermatitis because it can occur with shiitake mushroom ingestion, but it is usually nonpruritic in these cases. 3 Bleomycin-induced flagellate dermatitis has been seen in 8% to 20% of treated patients and is believed to be independent of route of delivery and dose, [1][2][3] with initial appearance varying from 2 hours after the first bleomycin dose to several weeks later after multiple administrations. 1,4,5 Flagellate dermatitis is often self-limited, but in severe cases the causal agent should be discontinued.…”

“…1,4,5 Flagellate dermatitis is often self-limited, but in severe cases the causal agent should be discontinued. 3…”