Flagellate erythema induced by bleomycin toxicity.

Bleomycin is a chemotherapeutic antibiotic used in various malignancies. Its toxicity is mainly lung and skin with marrow sparing effect. Here we would like to describe a characteristic skin reaction developed because of bleomycin in a case of intracranial germ cell tumor. Flagellate erythema which is a self-limiting toxic reaction can cause residual hyperpigmentation.

CASE

A 15-year-old boy diagnosed as intracranial germ cell tumor underwent surgery, followed by cranial radiotherapy (45 Gy) and later treated with Bleomycin, Etoposide and Cisplatin(BEP) regimen. After third cycle of chemotherapy, he developed asymptomatic erythematous rashes over the back, chest and thighs, which later subsided with persistence of hyperpigmentation [Figure 1].

Figure 1

Hyperpigmentation of flagellate erythematous rash over the back and thigh

Bleomycin is a chemotherapeutic antibiotic associated with various skin related toxicities such as Raynaud's phenomenon, flagellate erythema, and sclerodermoid reaction. In the acute stage they are erythematous rashes later may persist as hyperpigmentation marks.[1] Other conditions which may be associated with flagellate erythema are docetaxel, adult Still's disease, dermatomyositis and ingestion of shiitake mushrooms.[2] During the acute phase, topical with or without oral steroids may reduce symptoms.