Bleomycin-induced flagellate dermatitis in a South Indian patient with Hodgkin’s Lymphoma – A case report

Flagellate dermatitis is a rare skin reaction marked by linear or streak-like itchy red lesions, predominantly on the trunk and limbs. It is an uncommon cutaneous adverse effect of bleomycin, a chemotherapeutic drug used in treating cancers like Hodgkin’s lymphoma. The exact mechanism remains unclear. This case report details a 35-year-old male diagnosed with Hodgkin’s lymphoma who developed flagellate dermatitis after receiving doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy (adriamycin 25 mg, bleomycin 10 mg, vinblastine 6 mg, dacarbazine 520 mg). Six days post-treatment, he presented with intense itching and hyperpigmented, excoriated lesions on the neck, arms, chest, and back. A dermatologist confirmed the diagnosis of bleomycin-induced flagellate dermatitis. Treatment included the application of clindamycin gel, a combination of adapalene and clindamycin, an emollient lotion, an anti-acne cleansing bar, and oral levocetirizine 5 mg for 20 days. The patient showed gradual improvement. According to the World Health Organisation - Uppsala Monitoring Centre causality assessment, the skin reaction is possibly caused by bleomycin exposure.