Three Cases of Bleomycin-induced Flagellate Erythema (Scratch Dermatitis)

Abstract

We here report three cases of bleomycin-induced flagellate erythema presenting with severe cutaneous lesions. The patients were two females and one male, who all developed flagellate erythema on the trunk during chemotherapy regimens that included bleomycin for ovarian and testicular tumors. In two cases, flagellate erythema was not suspected at the initial visit; however, several days later, both patients exhibited worsening skin lesions characterized by linear erythema, leading to the diagnosis of flagellate erythema. The remaining patient complained of pruritus at the time of the initial bleomycin administration, and subsequently developed confluent and linear erythema on the back. Flagellate erythema (scratch dermatitis) usually presents with linear reddish or brownish streaks on the upper back. Clinicians should be aware that flagellate erythema presents with not only linear erythema but also macular erythema and/or plaques, and rapid progression and worsening can occur even when minimal erythema is observed at the initial presentation or after discontinuation of bleomycin therapy.