Flagellant dermatitis L81.4

Flagellant dermatitis (from lat. flagellum 'whip, flagellum') refers to streaky or flat, pigmented, itchy, inflammatory skin lesions described after chemotherapy of tumor patients with bleomycin, more rarely after cyclophosphamide or fluorouracil. The skin lesions occur in predisposed individuals in the sense of a dose-dependent toxic effect, they are reproducible and substance-specific.

Hyperpigmentation of the basal epithelial layer with marked pigment incontinence, wall-thickened blood vessels with irregularly contoured endothelial layer and markedly narrowed lumen, perivascular sparse round cell infiltrates.

Electron microscopy: Wall-thickened capillaries with narrow residual lumen, villus-like cytoplasmic extensions of the endothelium, onion-skin-like proliferating pericytes, in between fine granular, electron-dense material; abundant collagen fibrils, metabolically active melanocytes with abundant melanosomes.

After discontinuation of bleomycin, inflammatory changes disappear within a few weeks. However, the post-inflammatory pigmentation remains for months or years. Oral antihistamines against itching such as desloratadine (e.g. Aerius) 1-2 tablets/day. In the still florid state, short-term external glucocorticoids such as Betamethasone Lotio R030.

Remaining hyperpigmentation can be covered cosmetically if necessary ( camouflage), e.g. with Dermacolor.

1. Albig J et al (1992) Flagellate hyperpigmentation by bleomycin. dermatologist 43: 376-379
2. Altmeyer P et al (1984) A contribution to the pathogenesis of cutaneous bleomycin side effects. Act Dermatol 10: 191-196
3. Duhra P et al (1991) Bleomycin-induced flagellate erythema. Clin Exp Dermatol 16: 216-217
4. Nayak N et al (2003) Case 2 Bleomycin-induced flagellate dermatosis. Clin Exp Dermatol 28: 105-106