Severe flagellate erythema in idiopathic dermatomyositis

Recognizing Flagellate Erythema in Skin of Color: A Case of Shiitake Dermatitis

“…The reaction with bleomycin is commonly a dose-dependent reaction that may be related to the cytotoxic effect of the medication or a variety of inflammatory and pigmentation changes that can be induced as a result of anti-cancer activity [ 8 ]. Cases of idiopathic flagellate dermatitis have also been seen in conjunction with the typical dermatoses found in dermatomyositis (e.g., Gottron’s papules, heliotrope rash, and shawl sign), but it is only found to affect about 5% of patients [ 9 ]. With flagellate erythema in patients with dermatomyositis, the lesions are typically erythematous and localized to the trunk and proximal extremities, while bleomycin-induced flagellate dermatitis appears more brown and less inflammatory as the markings are thought to be related to melanosome activity in keratinocytes [ 9 ].…”

“…Cases of idiopathic flagellate dermatitis have also been seen in conjunction with the typical dermatoses found in dermatomyositis (e.g., Gottron’s papules, heliotrope rash, and shawl sign), but it is only found to affect about 5% of patients [ 9 ]. With flagellate erythema in patients with dermatomyositis, the lesions are typically erythematous and localized to the trunk and proximal extremities, while bleomycin-induced flagellate dermatitis appears more brown and less inflammatory as the markings are thought to be related to melanosome activity in keratinocytes [ 9 ]. Flagellate dermatitis can also be seen in adult-onset Still’s disease, but the more typical rash of this disease is a non-pruritic salmon-colored maculopapular rash.…”

Covert clues: the non-hallmark cutaneous manifestations of dermatomyositis

“…As the name implies, flagellate erythema is a linear, lacy, streak-like erythematous eruption of macules, papules, and/or plaques on the skin accompanied by pruritus or pain (Figure 1) (90,91). Initially described as a distinct side effect of bleomycin exposure, it has since been reported to arise in conjunction with a host of other agents and conditions, including DM (90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101). It is considered a rare manifestation of DM, observed in only 5% of patients in one cohort, and has been noted to occur both prior to and in tandem with the other classic cutaneous signs (101).…”

“…Only two cases have been reported in juvenile patients to date with the vast majority occurring in adults (97,102). Compared to its bleomycin-induced counterpart which is said to be more brownish in appearance, the flagellate erythema seen with DM is said to be more erythematous, a finding reflective of the higher degree of inflammation (96,98). Histopathologic information derived from 4 cases revealed the typical DM findings of interface dermatitis with a perivascular lymphocytic infiltrate (52,95,102,103).…”