Chemotherapy-induced Flagellate Rash: Bleomycin as Culprit

A 17-year-old male who was a known case of testicular malignancy on bleomycin cycles presented with 5-days onset of itchy, linear, erythematous wheal rash over trunk, proximal extremities, as well as scalp. The wheals were parallel as well as intersecting each other, suggestive of flagellate rash. Other causes of flagellate rash, such as dermatomyositis, mushroom poisoning, and adult-onset still’s disease were ruled out by the absence of characteristic features in history and examination. The term “flagellate” is derived from the word “flagellum” a Latin word for “whip.” Chemotherapy-induced flagellate dermatitis should be differentiated from the “true” or “mechanical” flagellation which is caused by a whip during punishment, abuse, or sexual practices.[1] Treatment is avoidance of the drug, which may result in the resolution of rash [Figure 1].Figure 1: (a) Clinical image of the back of the patient showing linear erythematous edematous parallel as well as intersecting wheals with few excoriations. (b) Clinical image of the scalp of the same patient showing a similar flagellate rashDeclaration of consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.