Journal of Clinical Oncology & Advanced Therapy

Abstract

Background: Bleomycin is a glycopeptide antibiotic that has played a pivotal role in oncology for over five decades. While pulmonary toxicity has historically attracted the greatest clinical attention, dermatological adverse effects are equally distinctive, pathognomonic, and often underestimated. These cutaneous events, particularly the striking flagellate erythema, not only impact patients’ quality of life but also serve as a win dow into the drug’s unique pharmacology and tissue-specific toxicity. Methods: We performed a comprehen sive review of the literature, integrating historical context, mechanistic insights, clinical case descriptions, and therapeutic considerations. Results: Dermatological toxicity was found to occur in 8–20% of treated patients, manifesting primarily as linear erythematous streaks that progress to hyperpigmentation. Histopa thology reveals dermal inflammation, melanophages, and vacuolar degeneration, reflecting drug accumula tion in skin devoid of bleomycin hydrolase. Conclusion: Recognition of these cutaneous toxicities is essential for the practicing oncologist. Their presence is seldom life-threatening, but they inform patient management, highlight the delicate balance between efficacy and toxicity, and remind us of the clinical vigilance required in modern oncologic practice.