Back issues No.4 - 2006 / Case Report  

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Flagellate Hyperpigmentation in a Scratched Area after Bleomycin for Pleurodesis-A Case Report and Review of the Literature-
Yi-Shan Liu , Ya-Hui Chen , Jyh-Seng Wang , Tien-Yi Tzung
Dermatol Sinica 24:269-274,2006

Bleomycin, derived from Streptomyces verticillus, is used extensively in anti-cancer, anti-viral, anti-bacterial, and anti-tumor therapy. We present herein a case of 50-year-old woman with right pleural effusion due to liver cirrhosis treated with a single intrapleural instillation of bleomycin for cavitary sclerosis. Generalized itching occurred within 24 hours. Subsequently, streak-like hyperpigmentation soon appeared in the post-scratched areas. A skin biopsy showed an obvious increase in the amount of melanin pigment throughout the epidermal layer without increased melanocytes. After topical application of corticosteroid, the pruritus and hyperpigmentation faded. We also review the literature and the various clinical and histopathological features associated with this cutaneous complication of bleomycin, discussing the possible pathogenic mechanisms.

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