a 15-year - old boy diagnosed as intracranial germ cell tumor underwent surgery , followed by cranial radiotherapy ( 45 gy ) and later treated with bleomycin , etoposide and cisplatin(bep ) regimen .
after third cycle of chemotherapy , he developed asymptomatic erythematous rashes over the back , chest and thighs , which later subsided with persistence of hyperpigmentation [ figure 1 ] .
hyperpigmentation of flagellate erythematous rash over the back and thigh bleomycin is a chemotherapeutic antibiotic associated with various skin related toxicities such as raynaud 's phenomenon , flagellate erythema , and sclerodermoid reaction . in the acute stage
they are erythematous rashes later may persist as hyperpigmentation marks . other conditions which may be associated with flagellate erythema are docetaxel , adult still 's disease , dermatomyositis and ingestion of shiitake mushrooms . during the acute phase , topical with or without oral steroids
 bleomycin is a chemotherapeutic antibiotic used in various malignancies . 
 its toxicity is mainly lung and skin with marrow sparing effect . 
 here we would like to describe a characteristic skin reaction developed because of bleomycin in a case of intracranial germ cell tumor . 
 flagellate erythema which is a self - limiting toxic reaction can cause residual hyperpigmentation . 
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