Resumen
Introducción: el eritema flagelado (EF) es una dermatosis de origen multifactorial, frecuentemente relacionada con el uso de ciertos fármacos. Se presenta en hasta 20% de los pacientes tratados con bleomicina. La acumulación del fármaco en la piel quizás se deba a la carencia de la enzima hidrolasa bleomicina. Se manifiesta con una dermatosis diseminada, predominante en tronco y extremidades superiores, caracterizada por máculas eritemato-hiperpigmentadas de tamaño variable, con disposición lineal y aspecto de "latigazos", asociadas a prurito intenso. El manejo se centra en aliviar el prurito con antihistamínicos y esteroides tópicos, aunque suspender la bleomicina es fundamental para la resolución completa.
Caso clínico: mujer de 19 años, con antecedente de disgerminoma de ovario izquierdo estadio IIIB, en tratamiento con quimioterapia combinada (bleomicina, etopósido y cisplatino). Tras 3 meses de tratamiento, presentó dermatosis diseminada en cuello y región posterior del tórax, constituida por manchas hiperpigmentadas de color marrón oscuro, con configuración lineal y tamaños variables, asociadas a prurito, sin otros síntomas. Se diagnosticó EF por bleomicina. Se indicó tratamiento con corticoesteroides tópicos de alta potencia. Tras suspender la bleomicina, hubo una desaparición progresiva de la dermatosis hasta su resolución completa.
Conclusión: se debe identificar el EF por bleomicina tempranamente para un manejo adecuado que permita continuar el tratamiento antineoplásico. La suspensión del fármaco debe considerarse cuando se comprometa la calidad de vida del paciente y se equilibre con el control oncológico, lo que optimiza el tratamiento antineoplásico.
Abstract
Background: Flagellate erythema (FE) is a multifactorial dermatosis, frecuently related to the the use of certain drugs. It can occur in up to 20% of patients treated with bleomycin. Drug accumulation in the skin can be due to the lack of the enzyme bleomycin hydrolase. It presents as a widespread dermatosis, predominantly affecting the trunk and upper extremities, characterized by erythematous-hyperpigmented macules of variable size, with a linear arrangement and a "whip-like" appearance, associated with intense pruritus. Management focuses on relieving pruritus with antihistamines and topical steroids, although discontinuation of bleomycin is essential for complete resolution.
Case report: A 19-year-old woman with a history of stage IIIB left ovarian dysgerminoma was undergoing combined chemotherapy (bleomycin, etoposide, and cisplatin). After 3 months of treatment, she developed a widespread dermatosis on the neck and posterior thoracic region, consisting of dark brown hyperpigmented spots with a linear configuration and variable sizes, associated with pruritus, without other symptoms. FE due to bleomycin was diagnosed. High-potency topical corticosteroids were prescribed. After discontinuing bleomycin, there was a progressive disappearance of the dermatosis until complete resolution.
Conclusion: The bleomycin-induced FE must be identified early for appropriate management that allows the continuation of antineoplastic treatment. Discontinuation of the drug should be considered when the patient's quality of life is compromised and balanced with oncological control, which optimizes antineoplastic therapy.
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