Bleomycin-Induced Flagellate Hyperpigmentation

The incidence may be as high as 20%.


Most tissues contain a cysteine proteinase capable of hydrolyzing and inactivating bleomycin.

The reduced concentration of bleomycin hydrolase in the skin and lung, as compared with other tissues, may explain the medication's adverse reaction profile.

The patient was counseled that the flagellate hyperpigmentation usually fades over a period of several months after the cessation of the medication.

During the past year, the hyperpigmentation in this patient has faded but not yet resolved.

(NEJM 363:e36December 9, 2010)