Abstract

Mucocutaneus side effects of bleomycin therapy are common in patients receiving cumulative doses greater than 100 U (100 mg). Flagellate hyperpigmentation is an interesting cutaneus reaction caused by bleomycin use, and is seen in about 8-20% of cases. The mechanism is unknown. Diagnosis is based on its characteristic clinical appearance. Histological examination of hyperpigmented skin lesions has demonstrated increased melanin content in basal keratinocytes. It has been suggested that mild cases may respond to antihistamines and ⁄ or systemic steroids, but in many cases discontinuation of the drug may be necessary. We present two patients (cumulative doses of 30 and 38 U) that developed bleomycin-induced flagellate hyperpigmentation with relatively low doses. Because the condition is not uncommon in patients who are using this drug, the clinician should be mindful of this complication.