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LT Alexander Abess, MC, USNR; LCDR Douglas M. Keel, MC, USNR; LCDR Brad S. Graham, MC, USNR

Arch Dermatol. 2003;139:337-339.

Background  Flagellate hyperpigmentation is a well-documented complication of systemic bleomycin sulfate therapy when using doses of 100 U or more as an antineoplastic agent. Two cases occurred after using systemic doses from 15 to 30 U injected intravenously or intrapleurally; however, it has not been described as a complication following intralesional treatment of verruca plantaris.

Observations  We report a case of flagellate hyperpigmentation after intralesional injection of 14 U of bleomycin for verrucae plantaris and review the literature associated with this cutaneous complication.

Conclusions  Flagellate hyperpigmentation from extremely low doses of intralesional bleomycin is a previously undescribed complication. Although the mechanisms of reaction are not clearly understood, the clinician should be mindful of this uncommon complication.

From the Department of Dermatology, Naval Medical Center San Diego, San Diego, Calif. The authors have no relevant financial interest in this article.

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