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

• Flagellate Dermatitis
• Scratch Dermatitis

What is Flagellate Erythema? (Definition/Background Information)

• Flagellate Erythema is an uncommon skin rash that has a specific linear streak pattern. The pattern resembles flagellation - as though the individual has been stuck by a whip (or whiplashed)
• The rash usually appears after chemotherapy (cancer therapy using medication), within a few days or weeks. However, Flagellate Erythema is also associated with adult-onset Still’s disease, consumption of shiitake mushroom, and dermatomyositis
• Flagellate Erythema is seen in both children and adults. It is believed that the itchy skin  rash develops secondary to an underlying condition, or even due to an adverse drug reaction
• Adequate treatment of the underlying condition may help resolve Flagellate Erythema. However, the skin condition is also known to get better spontaneously. In some individuals, symptomatic treatment using steroid medications or laser therapy may be necessary
• The prognosis of Flagellate Erythema is good in a majority of cases. However, the overall prognosis also depends on the underlying cause and its severity

Who gets Flagellate Erythema? (Age and Sex Distribution)

• Flagellate Erythema may occur at any age; both children and adults may be affected
• Both males and females may be affected
• Individuals of all racial and ethnic background can be affected

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

The risk factors for Flagellate Erythema may include a variety of factors such as:

• Chemotherapy using medications, such as bleomycin, peplomycin, and docetaxel, resulting in drug-induced Flagellate Erythema
• Adult-onset Still’s disease
• Dermatomyositis: A longstanding inflammatory disorder of the muscles that results in characteristic skin rashes
• Shiitake mushrooms: Consuming uncooked or poorly-cooked shiitake mushrooms can result in shiitake Flagellate Dermatitis
• Infectious diseases such as Chikungunya fever
• In rare cases, hypereosinophilic syndrome

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 Flagellate Erythema? (Etiology)

It is researched that Flagellate Erythema is not a disorder in itself; rather, it is a skin manifestation of other systemic conditions and occurs secondary to the associated systemic condition/factor. Such factors may include:

• Administration of chemotherapy medications is the most common cause of Flagellate Erythema. The common chemotherapy drug causing Flagellate Erythema is bleomycin
• Various health conditions such as Adult-onset Still’s disease, dermatomyositis, and hypereosinophilic syndrome
• Consuming undercooked shiitake mushrooms
• In some cases, the underlying cause of Flagellate Erythema is unknown, and it is termed idiopathic

Flagellate Erythema is a skin condition that is non-contagious. It cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Flagellate Erythema?

The signs and symptoms of Flagellate Erythema include:

• The 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
• Flagellate Erythema is typically itchy (pruritic)
• 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
• In case of chemotherapy-induced rash, the appearance of rash may take place within days to months of administering chemotherapy
• The skin rashes may ‘come and go’

How is Flagellate Erythema Diagnosed?

A diagnosis of 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
• Culture studies to rule out any infection
• 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 Flagellate Erythema?

The complications of Flagellate Erythema are typically from the presence of the underlying disorder/condition. In general, the complications 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)
• Applying heat to the area, where the rash was present can result in a recurrence of the rash. This is called heat-induced recall of Flagellate Erythema
• Recurrence of the skin rashes (due to other factors)
• Complications due to the presence of an associated condition, if any

How is Flagellate Erythema Treated?

The treatment of Flagellate Erythema depends on the underlying condition. Treating the underlying condition may result in a cure, in some cases. Moreover, in some individuals, the rash may get better on its own without treatment.

Typically, symptomatic treatment is provided for Flagellate Erythema, which 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 Flagellate Erythema be Prevented?

Currently, there are no known methods to prevent the occurrence of 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
• Treating any underlying infections/conditions early and adequately
• Inform your physician if you are allergic to certain medications

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

• The prognosis for 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
• However, the overall prognosis is also dependent on the underlying cause and severity of the symptoms presented

Additional and Relevant Useful Information for 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