Pruritic Erythematous Linear Plaques on the Neck and Back

Abstract

A 43-year-old homemaker with recently diagnosed immunoblastic lymphoma, stage III-A, and chronic active hepatitis, who had recently completed her second cycle of chemotherapy (including bleomycin sulfate, doxorubicin hydrochloride, cyclophosphamide, vincristine sulfate, and prednisone), presented with a markedly pruritic eruption over the neck and back. Lesions first developed on the patient's neck and were described as "papular" and "vesicular"; subsequently the eruption spread to a large area of the back and consisted of large, brightly erythematous linear plaques and patches. There were no aggravating or alleviating factors.Physical examination revealed circumscribed wide linear erythematous plaques and patches located over the posterior aspect of the patient's neck (Fig 1) and lower part of the back (Fig 2). There was no evidence of scale or atrophy. Results of the remainder of skin and mucous membranes examination were unremarkable.What is your diagnosis? Figure 1.Figure 2.Clinicians, local and regional societies, and residents andfellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced and in triplicate. Photomicrographs and illustrations must be clear and submitted as positive color transparencies (35 mm). Do not submit color prints unless accompanied by original transparencies. If photomicrographs are not available, the actual slide from the specimen will be acceptable.

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

“…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). FH is one of the most interesting side effects, and it may occur in 8-20% of patients who receive bleomycin treatment (4,6).…”

“…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). FH is one of the most interesting side effects, and it may occur in 8-20% of patients who receive bleomycin treatment (4,6). Diagnosis is based on the characteristic clinical appearance of skin lesions.…”

“…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).…”

Dermatite flagelada induzida pela bleomicina

“…It is generally pruriginous and it may have the likeness of postinflammatory hyperpigmentation from the beginning or start as erythematous urticaria-like lesions which progress to residual hyperpigmentation. [2][3][4][5] Its occurrence is variable, as it is described in a percent range from 8% to 66% of cases in different studies. Individual susceptibility seems to exist.…”

“…4,6 There are several histopathological changes described in flagellate dermatitis: hyperkeratosis, parakeratosis, acantosis, spongyosis, basal layer degeneration, lymphohistiocytic inflammatory infiltrate in the dermis, melanophages in the papillary dermis and lymphocytic vasculities without epidermal alteration. [3][4][5] There is a normal count of melanocytes, but electronic microscopy reveals an increased number of melanosomes in keratinocytes, forming dense perinuclear rings. 2,7 Pigmentation may persist for a long time, 3,4 as seen in case number 2.…”