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Winnie Yeo (Assistant Professor)
Conrad C.Y. Lee (Doctor)
Philip J. Johnson (Professor)
Department of Clinical Oncology, The Chinese University of Hong Kong
Prince of Wales Hospital, Hong Kong.
Flagellate pigmentation secondary to bleomycin is an uncommon but well-recognised localised skin hyperpigmentation reaction,1-3 and is often accompanied by pruritus and scratching. It is attributed to the reduced availability of inactivating enzymes for bleomycin in the skin.
In the present report, a 28-year-old woman underwent laparotomy to remove a 23 cm ovarian mass adherent to the omentum which was diagnosed
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as stage III dysgerminoma of the ovary. She received adjuvant chemotherapy with BEP bleomycin 30 mg intravenous bolus given weekly for 10 weeks; cisplatin 20 mg/m2 in 1 litre of saline infusion over 2 hours on days 1-5, every 3 weeks for 4 cycles; and etoposide 100 mg/m2 in 500 ml dextrose infusion over 1 hour on days 1-5, every 3 weeks for 4 cycles.
One day after the first dose of bleomycin, the patient developed pruritus over her right upper arm and anterior chest, and presented with skin pigmentation over the corresponding areas (photo). She developed further lesions behind her right ear, over the left forehead and on the limbs and trunk during her subsequent cycles of chemotherapy. There were no other undue toxicities.
References
1. Cohen IS, Mosher MB, O'Keefe EJ, et al. Cutaneous toxicity of beomycin therapy. Arch Dermatol 1973;107:553-555
2. Guillet G, Guillet MH, De Meaux H. Cutaneous pigmented stripes and bleomycin treatment. Arch Dermatol 1986;1:381-382.
3. Miori L, Vignini M, Rabbiosi G. Flagellate dermatitis after bleomycin. Am J Dermatopathol 1990;12:598-602.
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