Department of Dermatology, Venerology and Allergology, University of Leipzig, Germany.
Am J Clin Dermatol. 2011 Feb 1;12(1):68-76. doi: 10.2165/11537080-000000000-00000.
In oncology, bleomycin is a frequently used drug for the treatment of several malignancies. In particular, it is part of chemotherapy protocols in testicular cancer. We report on two patients with testicular cancer who received bleomycin-including chemotherapy and developed flagellate dermatitis. This is a typical adverse effect of bleomycin therapy; however, its pathophysiology has not yet been clarified. We discuss possible pathophysiologic mechanisms for this reaction. In general, it has been postulated that histopathologic findings in flagellate dermatitis share similarities with those observed in fixed drug eruptions. In fact, published cases in the literature have shown a broad variety of histologic changes and the histopathologic investigation of our two patients was not indicative of fixed drug eruption-like changes. Histology of one patient showed a superficial and deep, perivascular and periadnexal infiltrate of lymphocytes and eosinophils with a prominent perisudoral distribution, whereas the other patient was remarkable only for the presence of a rather sparse, superficial, perivascular lymphocytic infiltrate with occasional eosinophils and a few melanophages. Epidermal changes, in particular necrotic keratinocytes, were not present in either patient. We provide an overview of all reported histologic changes in bleomycin-induced flagellate dermatitis, including our experience with two patients. Based on these data, we present a summary of the clinical and histologic features.
在肿瘤学中，平阳霉素是一种常用于治疗多种恶性肿瘤的药物。特别是，它是睾丸癌化疗方案的一部分。我们报告了两名接受包含平阳霉素的化疗的睾丸癌患者发生鞭毛性皮炎。这是平阳霉素治疗的一种典型不良反应；然而，其病理生理学尚未阐明。我们讨论了这种反应的可能病理生理学机制。一般来说，鞭毛性皮炎的组织病理学发现与固定药物疹观察到的发现具有相似性。事实上，文献中已发表的病例显示出广泛的组织学变化，我们的两名患者的组织病理学检查并未显示出类似于固定药物疹的变化。一名患者的组织学表现为浅表和深部、血管周围和附属器周围的淋巴细胞和嗜酸性粒细胞浸润，并有明显的围汗腺分布，而另一名患者仅表现为稀疏的、浅表的、血管周围的淋巴细胞浸润，偶尔有嗜酸性粒细胞和少数黑素细胞。两名患者均无表皮变化，特别是坏死角质形成细胞。我们综述了平阳霉素引起的鞭毛性皮炎的所有报告的组织学变化，包括我们的两名患者的经验。基于这些数据，我们总结了临床和组织学特征。
