Flagellate dermatitis after bleomycin chemotherapy in a patient with malignant germ cell tumor

History and clinical findings: A 49-year-old patient with malignant germ cell tumor within the first cycle PEB (platinum [P], etoposid [E] and bleomycin [B]) presented with an itchy linear papular erythema with discrete vesicles. The rash had appeared three days ago i.e. four days after the second application of bleomycin. Investigations: Visual diagnosis of a flagellate dermatitis. Treatment and clinical course: Primary treatment consisted of systemic antihistamines, local and systemic application of steroids. Bleomycin treatment was stopped and substituted by ifosfamide. Conclusion: Flagellate dermatitis occurs with an incidence up to 66% after bleomycin treatment. There is no association between bleomycin dose and incidence or severity of the lesions. Flagellate dermatitis is a self-limiting condition but hyperpigmentation may persist. Similar lesions may occur with bendamustine and docetaxel, the intake of insufficiently cooked shiitake mushrooms as well as in dermatomyositis and Still's syndrome.