Flagellate erythema secondary to bleomycin: case report with favorable outcome

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.