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Cutaneous hyperpigmentation following bleomycin sclerotherapy for vascular malformations
Kyle P Davis1, Megan M Gaffey1,2,3, Anvesh R Kompelli1
1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Pediatric Dermatology
|December 13, 2021
Summary
Direct puncture sclerotherapy using bleomycin for vascular malformations may cause skin hyperpigmentation, indicating systemic drug absorption. Patients should be informed about this risk and preventive measures discussed.
Area of Science:
- Dermatology
- Vascular Surgery
- Pharmacology
Background:
- Systemic bleomycin therapy is known for pulmonary fibrosis and skin side effects.
- Intralesional bleomycin is commonly used for treating vascular malformations (VMs).
- Current understanding suggests minimal systemic distribution of bleomycin during VM treatment.
Observation:
- A case series observed cutaneous, adhesive-related hyperpigmentation in patients treated with bleomycin for VMs.
- This hyperpigmentation suggests unintended systemic absorption of bleomycin.
- The side effect occurred following direct puncture sclerotherapy (DPS).
Findings:
- Direct puncture sclerotherapy (DPS) with bleomycin can lead to systemic bleomycin egress.
- Cutaneous hyperpigmentation is a potential indicator of systemic bleomycin absorption post-DPS.
- The risk of hyperpigmentation necessitates patient counseling and risk mitigation strategies.
Implications:
- Clinicians should discuss the risk of hyperpigmentation with patients undergoing bleomycin DPS for VMs.
- Implementing measures to minimize bleomycin systemic absorption is crucial.
- This finding warrants further investigation into bleomycin pharmacokinetics during sclerotherapy.
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