Incidencia de Hiperpigmentación Inducida por Bleomicina en Pacientes Sometidos a Escleroterapia para Malformaciones...

To determine the incidence of bleomycin-induced hyperpigmentation in patients receiving bleomycin sclerotherapy for low-flow vascular malformations (LFVM).

A retrospective chart review of patients with radiologically confirmed LFVM who had undergone ≥ 1 bleomycin sclerotherapy session. Treatments were performed at [Blinded] or [Blinded] between January 2010 and September 2024. Incidence was calculated per patient and per session using exact binomial 95% confidence intervals (CIs), and treatment and dosing variables were summarized descriptively.

Hyperpigmentation occurred in 11 of 333 patients (3.3%; 95% CI, 1.7-5.8) across 11 of 701 treatment sessions (1.6%; 95% CI, 0.8-2.8). Affected patients included 6 females and 5 males. Reactions developed after one, two, or three treatments in 1.5% (5/333), 1.2% (2/164), and 3.4% (3/87) of sessions, respectively, with an additional case after ≥4 treatments (0.9%, 1/117). The overall cohort's median per-session and cumulative doses were 9 units [interquartile range (IQR) 9] and 12.5 units [IQR 16.5], respectively. Among patients who developed hyperpigmentation, the median session dose prior to reaction was 11.3 units [IQR 8], and the median cumulative dose at the time of reaction was 15 units [IQR 21]. All cases occurred without an adjunct sclerosant being administered. Hyperpigmentation involved multiple body regions in 8 patients, while 3 patients had isolated involvement, including two localized to the back and one to the hand.

Bleomycin-induced hyperpigmentation was uncommon in LFVM sclerotherapy. These findings can inform patient consent and counselling on the risk of hyperpigmentation.