title: Flagellate hyperpigmentation following intralesional bleomycin treatment of verruca plantaris.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Dermatology, Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Abess
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Keel
authors.forename: Brad S
authors.initials: BS
authors.lastname: Graham
mesh_terms: D000005:Abdomen; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005533:Foot Dermatoses / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000473:pathology; D015552:Injections, Intralesional; D014860:Warts / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin