Heat-induced recall of bleomycin skin changes

Abstract

Following bleomycin administration, a patient developed alopecia and hyperpigmentation. An unusual skin reaction occurred with the use of a heating pad which has been termed a heat‐induced “recall” phenomenon.

Flagellate erythema

“…Patch tests with bleomycin show as negative, but flagellate erythema may recur on a re‐challenge 21 . A peculiar heat‐induced recall phenomenon has been reported, which showed recurrence of reticular hyperpigmentation in the area of the heating pad applied after a few months of stoppage of bleomycin owing to linear hyperpigmentation 31 . This phenomenon may be explained by the previous observations that hyperthermia enhances the toxicity of bleomycin 32…”

“…Another possible mechanism of efficacy is the induction of tumor necrosis factor (TNF) 33 . During intralesional bleomycin therapy for verruca plantaris, a case of flagellate hyperpigmentation has recently been reported, even after small intracutaneous doses 31 …”

Bleomycin and the skin

“…Patch tests with bleomycin may be negative, but flagellate erythema may recur on rechallenge 51 . A peculiar heat‐induced recall phenomenon was also reported in which reticular hyperpigmentation caused by contact with a heating pad recurred, even after stoppage of bleomycin use 59 . This phenomenon underscores the previous observations that hyperthermia enhances the toxicity of bleomycin 60…”

Flagellate Dermatitis in a Child Most Likely Secondary to Doxorubicin

“…Intravenous dexamethasone and cooling before further chemotherapeutic cycles have been shown to prevent recurrences after reexposure to the antineoplastic agent . FD recurrences have been associated with heat‐induced recall . Our patient underwent eight cycles of chemotherapy that included doxorubicin without FD recurrence, which the concomitant use of topical corticosteroids could explain.…”