What are the other Names for this Condition? (Also known as/Synonyms)

• Flagellate Erythema due to Bleomycin

What is Bleomycin-Induced Flagellate Erythema? (Definition/Background Information)

• Bleomycin-Induced Flagellate Erythema is an uncommon skin condition that develops following chemotherapy (cancer therapy using bleomycin medication), within a few days, weeks, or even after a few months
• Flagellate erythema is a type of skin rash that has a specific linear streak pattern. The pattern resembles flagellation - as though the individual has been beaten by a whip (or whiplashed)
• The dosage of bleomycin may or may not affect the incidence of the rash. As high as two-thirds of the individuals have been known to present flagellate erythema after undergoing chemotherapy, in some study groups
• Bleomycin-Induced Flagellate Erythema may be seen in both children and adults. It is believed that the itchy skin rash develops secondary to administering chemotherapy medication (as an adverse drug reaction)
• The skin condition is known to get better spontaneously following avoidance of bleomycin. In some individuals, symptomatic treatment using steroid medications or laser therapy may be necessary
• The prognosis of Bleomycin-Induced Flagellate Erythema is good in a majority of cases. However, the overall prognosis depends on the underlying reason for administering chemotherapy

Who gets Bleomycin-Induced Flagellate Erythema? (Age and Sex Distribution)

• Bleomycin-Induced Flagellate Erythema may occur at any age; both children and adults may be affected
• The incidence rate of the condition is between 8% to 66% (i.e., percentage of individuals treated with bleomycin manifesting flagellate erythema)
• Both males and females may be affected
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Bleomycin-Induced Flagellate Erythema? (Predisposing Factors)

• Individuals undergoing chemotherapy using bleomycin are at an increased risk for developing Bleomycin-Induced Flagellate Erythema

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bleomycin-Induced Flagellate Erythema? (Etiology)

• Bleomycin-Induced Flagellate Erythema can be defined as an adverse reaction of the body to bleomycin that is used to treat some types of cancer
• It is believed that the offending medication potentially causes an abnormal cell-mediated immune response in the body, which results in the formation of characteristic lesions on the skin
• The dosage of bleomycin does not seem to affect the incidence of the rash. In some individuals, the condition is reportedly dose-dependent; while in others, it is not dependent upon the medication dose

What are the Signs and Symptoms of Bleomycin-Induced Flagellate Erythema?

The signs and symptoms of Bleomycin-Induced Flagellate Erythema include:

• The bleomycin-induced skin rash appears within days to months of administering chemotherapy
• The itchy (pruritic) rash occurs as red linear whiplash-like streak on any part of the body skin
• The skin rash may also be present as patches and plaques on bony prominences
• Scratching and rubbing the area may make the condition worse, resulting in bleeding
• It occurs usually on the back and flank region; trunk or chest, and on the extremities
• Other symptoms of chemotherapy side effects may be observed in some individuals

How is Bleomycin-Induced Flagellate Erythema Diagnosed?

A diagnosis of Bleomycin-Induced Flagellate Erythema may involve the following:

• A thorough medical history assessment and complete physical examination
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests to diagnose underlying disorders, if needed
• Culture studies to rule out any infection, if any
• Imaging studies to diagnose underlying conditions, if any
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bleomycin-Induced Flagellate Erythema?

The complications of Bleomycin-Induced Flagellate Erythema may include:

• Cosmetic issues that result in emotional stress
• Bleeding and ulceration of the skin may result in secondary viral or bacterial infections
• The rash can cause hyperpigmentation (increased skin pigmentation)
• Recurrence of the skin rashes, which may be worse or severe than before

How is Bleomycin-Induced Flagellate Erythema Treated?

Typically, symptomatic treatment is provided for Bleomycin-Induced Flagellate Erythema, since there is no specific treatment for the condition. In some individuals, the skin rash may get better on its own without treatment. The treatment measures may include:

• Topical steroid creams and oral steroids for itchy skin
• Cooling the area of the rash can be helpful
• Skin hyperpigmentation can be treated using laser therapy, if it causes significant cosmetic concerns
• Treatment of any other symptoms

How can Bleomycin-Induced Flagellate Erythema be Prevented?

Currently, there are no known methods to prevent the occurrence of Bleomycin-Induced Flagellate Erythema. However, one may lower the risk for the skin condition by considering the following factors:

• It is reported that staying in a cool environment immediately before the chemotherapy session may help prevent the rash
• Inform your physician if you are allergic to any medication(s)

What is the Prognosis of Bleomycin-Induced Flagellate Erythema? (Outcomes/Resolutions)

• The prognosis for Bleomycin-Induced Flagellate Erythema is usually good, in many cases, since it is a benign skin condition
• In some individuals, the condition is known to resolve without treatment. It take many months to even years to clear completely, after stoppage of medication use
• Nevertheless, the overall prognosis is also dependent on the underlying cause of administering chemotherapy (such as cancer)

Additional and Relevant Useful Information for Bleomycin-Induced Flagellate Erythema:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse