Flagellate hyperpigmentation

History

       A 40-year-old lady had choriocarcinoma treated with chemotherapy. Bleomycin was one of her treatment regimen. After few doses of bleomycin she developed linear hyperpigmentation on her back. Many brownish lines arranged in a haphazard way on the back. ‘Flagellate’ streaked pigmentation on the trunk and proximal extremities is common with bleomycin usage. It has been proposed that trauma from scratching induces localized vasodilatation, with increased concentration of cutaneous bleomycin.