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Muacevic A, Adler JR, Tan W. Appearance of a "Whip-Like" Rash in a Young Male Undergoing Therapy for Testicular Embryonal Carcinoma. Cureus 2022; 14:e33065. [PMID: 36721590 PMCID: PMC9883062 DOI: 10.7759/cureus.33065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Bleomycin, a cytotoxic antibiotic commonly used as part of combination chemotherapy regimes in the treatment of germ cell tumors, is well known among clinicians for its potential pulmonary toxicity. Less well known, although postulated to occur through a similar pathomechanism, are the wide spectrum of dermatologic adverse reactions associated with bleomycin therapy. The current case report describes the sudden and distressing appearance of a pruritic erythematous flagellate "whip-like" rash in a 30-year-old Caucasian male undergoing treatment for testicular embryonal carcinoma following the second infusion of bleomycin-containing chemotherapy. Diagnosed as bleomycin-induced flagellate dermatitis, the case describes the dermatologic sequela and therapeutic interventions utilized. While commonly used in testicular cancer, decreasing use of bleomycin-containing chemotherapy regimens has made the appearance of this increasingly rare, yet important and distressing, toxic adverse reaction a diagnostic challenge. Given that patients may present acutely to primary care providers, dermatologists, and nurse practitioners, awareness of this rare adverse reaction is important in order to alleviate patient anxiety, initiate appropriate therapy, set expectations of expected dermal sequela, and initiate an informed collaborative discussion regarding the continuation versus cessation of bleomycin-containing therapy.
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Verma P, Rajaram S, Heda A, Sundriyal D, Tiwari P, Sahoo I, Panta S, Bordoloi M, Bhan H, Sharma D. Bleomycin-Induced Flagellate Dermatitis: Revisited. Cureus 2022; 14:e29221. [PMID: 36258994 PMCID: PMC9571210 DOI: 10.7759/cureus.29221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
Flagellate dermatitis caused by bleomycin is a rare side effect with a distinctive pattern of whip-like, linear streaks. The clinical presentation has become uncommon nowadays as bleomycin use in conventional chemotherapy regimens has decreased. We present a case of a 30-year-old female diagnosed with ovarian germ cell tumour, managed with bleomycin, etoposide, and cisplatin (BEP) and later developed a widespread rash indicative of classic flagellate dermatitis. This brief report emphasizes the significance of detection and management of this transient dermatological complication in patients receiving bleomycin.
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Constantinou A, Kotecha D, Laouris P, de Paula B. A closer look at chemotherapy-induced flagellate dermatitis. SKIN HEALTH AND DISEASE 2022; 2:e92. [PMID: 35665202 PMCID: PMC9060014 DOI: 10.1002/ski2.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Flagellate dermatitis (FD) is a rare skin rash, which may occur following the administration of antineoplastic agents. It has been reported following the administration of bleomycin, docetaxel, trastuzumab, cisplatin, bendamustine and doxorubicin. We provide a summary of the epidemiology, aetiology, pathophysiology, and distribution of chemotherapy-induced FD. METHODS PubMed was searched using ((flagellat*) AND (Dermat*)) OR ((Flagellat*) AND (Erythema)). The search yielded 206 publications, out of which 54 individual case reports were identified which fulfilled our inclusion criteria. Statistical analysis was performed where appropriate. RESULTS Female patients were slightly more likely to develop FD compared to males. In the majority of cases FD appeared on the upper and lower limbs and pruritus was an accompanying feature in 51% of cases. Most cases developed after the first cycle of chemotherapy and females were statistically more likely to present within the first 72 hr (p <0.05). Skin biopsies were taken in 41% of cases and this was not statistically associated with the patient's gender, (p = 0.651), presentation within 72 hr (p = 0.076) or cancer diagnosis. Chemotherapy was stopped in 62% of patients and was associated with female gender (p = 0.0098). Most patients who received treatment were managed with topical steroids. Time for rash resolution ranged from a few weeks to four months following the discontinuation of the causative drug. CONCLUSION FD is a rare adverse skin effect of chemotherapeutic treatment, most commonly presenting on the upper and lower limbs of patients following their first cycle of chemotherapy. Early presentation is more common in females leading to increased likelihood of stopping chemotherapy. Biopsy findings poorly correlate with disease severity. Continuation of chemotherapy treatment in combination with topical steroids may not adversely affect rash resolution.
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Affiliation(s)
- A. Constantinou
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - D. Kotecha
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - P. Laouris
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - B. de Paula
- Department of OncologyUniversity of CambridgeCambridgeUK
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Abstract
Drug-induced pigmentation accounts for up to 20% of all cases of acquired pigmentation. A thorough review of medical history and previous and ongoing medications as well as a complete skin examination can guide diagnosis. Implicated agents include alkylating/cytotoxic agents, analgesics, antiarrhythmics, anticoagulants, antiepileptics, antimalarials, antimicrobials, antiretrovirals, metals, prostaglandin analogs, and psychotropic agents, among others. Confirming true drug associations can be challenging, especially in the setting of delayed onset of pigmentation and coexisting polypharmacy.
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Affiliation(s)
- Amanda F Nahhas
- Department of Dermatology, Beaumont-Farmington Hills, Farmington Hills, MI, USA
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA
| | - Taylor L Braunberger
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA.
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Abstract
Flagellate erythema is a distinctive eruption characterized by "whip-like" linear or curvilinear streaks and plaques, occurring mainly on the trunk. It has classically been described in 2 disparate clinical settings: chemotherapy with bleomycin and ingestion of mushrooms (most commonly Shiitake mushrooms). Most of the literature comprises single case reports, often with minimal histological description of rather nonspecific features. We describe in detail the histological features of 3 cases of flagellate erythema (2 related to bleomycin therapy and one related to ingestion of mushrooms) and review the findings described in the literature to define the spectrum of histological changes encountered in this eruption. Our 3 cases showed mild epidermal changes, with spongiosis and variable interface inflammation. All 3 showed a relatively prominent dermal lymphohistiocytic infiltrate, with features suggestive of a lymphocytic vasculopathy extending to at least the mid-reticular dermis. Eosinophils were a prominent component of the inflammatory infiltrate in 2 cases. Our review of the literature identified a total of 45 publications, representing reports of 46 patients, containing histological information. As well as bleomycin- and mushroom-related cases, similar eruptions have been reported in the context of connective tissue disease and other drugs. Although cases related to connective tissue disease show features of the underlying condition, cases secondary to drugs or mushrooms predominantly show features compatible with common patterns of exanthematous/morbilliform drug reaction. In particular, subtle spongiosis and/or interface dermatitis combined with a dermal lymphocytic infiltrate that includes increased numbers of eosinophils is a common finding. Features of a lymphocytic vasculopathy may be seen in a subset of these cases.
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Masatkar V, Nagure A, Gupta LK. Unusual and Interesting Adverse Cutaneous Drug Reactions. Indian J Dermatol 2018; 63:107-116. [PMID: 29692451 PMCID: PMC5903039 DOI: 10.4103/ijd.ijd_584_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR.
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Affiliation(s)
- Vaishali Masatkar
- Department of Dermatology, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Ashok Nagure
- Department of Dermatology, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
| | - Lalit Kumar Gupta
- Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India
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Cohen PR. Antineoplastic therapy-associated flagellate dermatoses. Int J Dermatol 2017; 56:1490-1491. [DOI: 10.1111/ijd.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/17/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Philip R. Cohen
- Department of Dermatology; University of California San Diego; La Jolla CA USA
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Biswas A, Julka PK. Bleomycin induced flagellate erythema in a patient with thalamic mixed germ cell tumour: Report of a rare adverse effect. J Egypt Natl Canc Inst 2016; 28:129-32. [PMID: 27106629 DOI: 10.1016/j.jnci.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/20/2016] [Accepted: 04/01/2016] [Indexed: 12/28/2022] Open
Abstract
Bleomycin induced flagellate dermatitis is an uncommon and unique adverse effect. With the declining use of bleomycin, this complication is becoming increasingly infrequent in day-to-day clinical practice. We herein describe a case of a 13year old male patient with left thalamic mixed germ cell tumour treated by multimodality approach, who developed flagellate erythema after two cycles of combination chemotherapy with bleomycin, etoposide and cisplatin (BEP). This brief report highlights the importance of awareness and timely identification and management of this dermatological toxicity in patients undergoing bleomycin based combination chemotherapy.
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Affiliation(s)
- Ahitagni Biswas
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Pramod Kumar Julka
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India
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Vadeboncoeur S, Côté B. Flagellate Pattern of Toxic Erythema of Chemotherapy Due to Doxorubicin: A Case Report. J Cutan Med Surg 2016; 20:481-3. [PMID: 27068228 DOI: 10.1177/1203475416644831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Doxorubicin is an antineoplastic agent frequently used in diverse cancer regimens. Cutaneous adverse effects have frequently been reported with its use. However, a flagellate-like dermatitis is not mentioned in the literature. OBJECTIVE The investigators report a case of toxic erythema of chemotherapy with a flagellate pattern induced by doxorubicin. METHODS AND RESULTS A 75-year-old woman with endometrial cancer received doxorubicin as part of her treatment. After her third cycle, she presented a pruritic vesiculobullous eruption, with linear elements that left hyperpigmented streaks on follow-up. A biopsy was compatible with a drug eruption. CONCLUSION Doxorubicin is a well-known cause of toxic erythema of chemotherapy. As seen in this patient, the investigators suggest that it also be added to the list of causes of flagellate dermatosis.
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Affiliation(s)
| | - Benoît Côté
- Division of Dermatology, Université de Montréal, Montreal, QC, Canada
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10
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Yamamoto T. Flagellate erythema induced by cisplatin. Clin Exp Dermatol 2016; 41:562-3. [PMID: 26931175 DOI: 10.1111/ced.12830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- T Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan.
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Trastuzumab-Associated Flagellate Erythema: Report in a Woman with Metastatic Breast Cancer and Review of Antineoplastic Therapy-Induced Flagellate Dermatoses. Dermatol Ther (Heidelb) 2015; 5:253-264. [PMID: 26506993 PMCID: PMC4674452 DOI: 10.1007/s13555-015-0085-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Flagellate erythema presents as erythematous, individual and intermingled, linear streaks in a whiplash-like pattern. Several conditions, including antineoplastic agents, have been associated with flagellate erythema. A woman with metastatic breast cancer who developed flagellate erythema after receiving trastuzumab is described and the features of flagellate erythema associated with other antineoplastic agents are reviewed. Methods PubMed was used to search the following terms, separately and in combination: agent, antineoplastic, bendamustine, bleomycin, breast, cancer, chemotherapy, dermatitis, dermatosis, docetaxel, erythema, flagellate, Herceptin, pigmentation, peplomycin, therapy, and trastuzumab. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated. Results The woman’s pruritus and skin lesions promptly resolved after treatment with corticosteroids (oral and topical) and antihistamines (oral); premedication with dexamethasone prior to each subsequent trastuzumab treatment prevented recurrence of flagellate erythema. Chemotherapy-induced flagellate erythema was initially described in oncology patients who received bleomycin. In addition to trastuzumab, other antineoplastic agents that have been associated with the development of flagellate erythema include bendamustine, docetaxel, and peplomycin. Conclusion Cutaneous adverse events to trastuzumab are uncommon. However, flagellate erythema should be added to the potential side effects of trastuzumab. In addition, trastuzumab should be added to the list of antineoplastic agents that may be associated with flagellate erythema. Electronic supplementary material The online version of this article (doi:10.1007/s13555-015-0085-2) contains supplementary material, which is available to authorized users.
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Masson Regnault M, Gadaud N, Boulinguez S, Tournier E, Lamant L, Gladieff L, Roche H, Guenounou S, Recher C, Sibaud V. Chemotherapy-Related Reticulate Hyperpigmentation: A Case Series and Review of the Literature. Dermatology 2015; 231:312-8. [PMID: 26422424 DOI: 10.1159/000439047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inherited or acquired reticulate hyperpigmentation represents a heterogeneous group of infrequent dermatological conditions. The development of reticulate hyperpigmentation has so far been rarely reported to be associated with chemotherapeutic agents, including fluorouracil, bleomycin or a combination of cytarabine and idarubicin. CASE REPORTS We describe 5 cases of chemotherapy-related reticulate hyperpigmentation in patients treated with different chemotherapeutic regimens, in particular paclitaxel or cytarabine. The lesions were similar in all cases, with reticulate and/or linear hyperpigmented streaks, which were mainly located to the back and buttocks. Histology showed increased melanogenesis, which suggests a direct toxic effect of chemotherapy on melanocytes. Reflectance confocal microscopy was performed in 2 patients showing a similar pattern, with an increased amount of melanin in basal keratinocytes. These features have been compared with the available data through a literature review. CONCLUSION Reticulate hyperpigmentation is an underestimated but characteristic complication of chemotherapy. Neither specific management nor discontinuation of the chemotherapeutic regimen is required.
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Affiliation(s)
- Marie Masson Regnault
- Department of Dermatology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
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Pereira LC, Nogueira TA, Barbosa LADO, Calil-Elias S, Castilho SRD. Adverse reactions to docetaxel: an active survey. BRAZ J PHARM SCI 2015. [DOI: 10.1590/s1984-82502015000300007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The rates of breast cancer mortality remain high in Brazil. Docetaxel is a semi-synthetic taxane used to treat various tumors, particularly tumors of the breast, lung and prostate. In this study ADR that occurred in 45 docetaxel users with breast cancer were surveyed. They were identified by type, causality (Naranjo algorithm and World Health Organization categories) and, if considered probable or defined, rated for severity according to SOBRAFO proposal (2007). A total of 325 ADR were observed: 165 in the first, 137 in the second and 23 in the third cycle. Fifty seven ADR were immediate and the others, late. Fatigue and exhaustion for more than five days, classified as Grade 3 by SOBRAFO (2007), were reported as the primary late RAM. There was no significant difference in the occurrence of immediate and late ADR between cycles (p=1 and p=0.3577, respectively). The presence of a pharmacist gave the patients a better understanding of the occurrence of RAM, especially those that occur outside the hospital, between chemotherapy cycles and are often not reported to the healthcare team, creating institutional demands and reaching the goal to track, observe and correlate the RAM for each user.
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14
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Molin S, Summer B, Thomas P, Letulé V, Ruzicka T, Ruëff F, Herzinger T. Boletus dermatitis: a new variant of flagellate erythema. Ann Allergy Asthma Immunol 2015. [PMID: 26195440 DOI: 10.1016/j.anai.2015.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sonja Molin
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Peter Thomas
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Valerie Letulé
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Thomas Herzinger
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany.
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Bleomycin-induced Flagellate Erythema: A Rare and Unique Drug Rash. W INDIAN MED J 2015; 63:807-9. [PMID: 25867573 DOI: 10.7727/wimj.2014.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/27/2014] [Indexed: 11/18/2022]
Abstract
Bleomycin-induced flagellate erythema is a rare rash associated with the use of the drug. The rash has a characteristic and intermingled lacy appearance as if it has been whipped. Lack of detoxifying enzymes for bleomycin in the skin makes it a vulnerable site for the adverse effects of bleomycin, along with the lungs. We report the case of young girl with germ cell tumour who developed bleomycin-induced flagellate erythema.
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Vennepureddy A, Siddique MN, Odaimi M, Terjanian T. Bleomycin-induced flagellate erythema in a patient with Hodgkin’s lymphoma – A case report and review of literature. J Oncol Pharm Pract 2015; 22:556-60. [DOI: 10.1177/1078155215580468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bleomycin is a glycopeptide used as a chemotherapeutic agent for lymphomas, germ cell tumors, and pleurodesis of malignant pleural effusions. The pulmonary toxicity of bleomycin is well known while the cutaneous side effects are uncommon and varies from generalized hyperpigmentation, sclerodermoid changes, erythema multiformae, and gangrene to flagellate dermatosis. Here we report a characteristic but rare side effect of flagellate erythema, which developed secondary to bleomycin in a 27-year old woman with Hodgkin’s lymphoma after two cycles of treatment with adriamycin, bleomycin, vinblastine, dacarbazine regimen. The rash subsided after discontinuation of bleomycin and treatment with steroids.
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Affiliation(s)
- A Vennepureddy
- Department of Medicine, Staten Island University Hospital, Staten Island, NY
| | - MN Siddique
- Division of Hematology and Oncology, Staten Island University Hospital, Staten Island, NY
| | - M Odaimi
- Division of Hematology and Oncology, Staten Island University Hospital, Staten Island, NY
| | - T Terjanian
- Division of Hematology and Oncology, Staten Island University Hospital, Staten Island, NY
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17
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Loo HV, Oon HH. Flagellate dermatitis following consumption of shiitake mushroom. Dermatol Reports 2011; 3:e21. [PMID: 25386273 PMCID: PMC4211525 DOI: 10.4081/dr.2011.e21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 08/10/2011] [Indexed: 12/30/2022] Open
Abstract
Japanese dermatologists were the first to describe the very characteristic flagellate dermatitis following consumption of undercooked or raw shiitake mushroom (Lentinus edodes). These similar eruptions were also reported in patients treated with bleomycin, in dermatomyositis and adult onset Still's disease. We report a case where a 40 year old chinese female developed flagellate dermatitis following ingestion of a bun containing shiitake mushroom.
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Ziemer M, Goetze S, Juhasz K, Elsner P. Flagellate dermatitis as a bleomycin-specific adverse effect of cytostatic therapy: a clinical-histopathologic correlation. Am J Clin Dermatol 2011; 12:68-76. [PMID: 21067249 DOI: 10.2165/11537080-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In oncology, bleomycin is a frequently used drug for the treatment of several malignancies. In particular, it is part of chemotherapy protocols in testicular cancer. We report on two patients with testicular cancer who received bleomycin-including chemotherapy and developed flagellate dermatitis. This is a typical adverse effect of bleomycin therapy; however, its pathophysiology has not yet been clarified. We discuss possible pathophysiologic mechanisms for this reaction. In general, it has been postulated that histopathologic findings in flagellate dermatitis share similarities with those observed in fixed drug eruptions. In fact, published cases in the literature have shown a broad variety of histologic changes and the histopathologic investigation of our two patients was not indicative of fixed drug eruption-like changes. Histology of one patient showed a superficial and deep, perivascular and periadnexal infiltrate of lymphocytes and eosinophils with a prominent perisudoral distribution, whereas the other patient was remarkable only for the presence of a rather sparse, superficial, perivascular lymphocytic infiltrate with occasional eosinophils and a few melanophages. Epidermal changes, in particular necrotic keratinocytes, were not present in either patient. We provide an overview of all reported histologic changes in bleomycin-induced flagellate dermatitis, including our experience with two patients. Based on these data, we present a summary of the clinical and histologic features.
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Affiliation(s)
- Mirjana Ziemer
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Germany.
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Allende I, González-Hermosa R, Lázaro M, Díaz-Pérez J. Psoriasis inducida por docetaxel. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100:629-30. [PMID: 19715656 DOI: 10.1016/s0001-7310(09)71919-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Allende I, González-Hermosa R, Lázaro M, Díaz-Pérez J. Docetaxel-induced Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Chew L, Chuen VSL. Cutaneous reaction associated with weekly docetaxel administration. J Oncol Pharm Pract 2008; 15:29-34. [DOI: 10.1177/1078155208096111] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background. Docetaxel-based chemotherapy will remain clinically relevant and many of our patients will continue to receive the drug. In a recent phase 2 study of docetaxel 35 mg/m2 (weekly) in patients with metastatic breast cancer, the incidence of grade 3 cutaneous toxicity is 19%. The skin toxicity observed consists of limb/palmar-plantar erythematous reactions, or fixed-plaque erythrodysesthesia. Case series or reports have reported varied manifestations of skin reactions and include erythema multiforme, nail changes (onycholysis, pigmentation, paronychia), scleroderma, supravenous discoloration, radiation recall dermatitis, and flagellate erythema. Method. We would like to report four patients with cutaneous reactions resulting from weekly administration of docetaxel. Results. All cases are heavily pre-treated patients, receiving docetaxel as second or third line therapy. The cutaneous reactions occur at cycle 5. The time between chemotherapy to development of skin lesions is from 1 to 7 days. Lesions usually resolve with desquamation leaving behind areas with hyper-pigmentation or hypo-pigmentation over a period of 2 to 3 weeks. The management strategies include hand elevation, warm or cold compresses, topical and/or systemic antibiotics, topical and/or systemic corticosteroids, and cessation of drug. Conclusions. There is a need for a systematic approach to manage these cutaneous reactions. Oncology trained pharmacists play vital roles in assessing, managing, documenting and patient education. J Oncol Pharm Practice (2009) 15: 29—34.
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Affiliation(s)
- Lita Chew
- National Cancer Centre Singapore, National University of Singapore, 11 Hospital Drive, Singapore 169610,
| | - Vivianne Shih Lee Chuen
- National Cancer Centre Singapore, National University of Singapore, 11 Hospital Drive, Singapore 169610
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