Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2016; 4(12): 390-400
Published online Dec 16, 2016. doi: 10.12998/wjcc.v4.i12.390
Paclitaxel-associated reticulate hyperpigmentation: Report and review of chemotherapy-induced reticulate hyperpigmentation
Philip R Cohen
Philip R Cohen, Department of Dermatology, University of California San Diego, San Diego, CA 92131-3643, United States
Author contributions: Cohen PR designed the report, performed the research, collected the patient’s clinical data, analyzed the data, and wrote the paper.
Institutional review board statement: The study was reviewed and approved by the University of California San Diego Institutional Review Board.
Informed consent statement: The study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Philip R Cohen has no conflicts of interest. He has received no fees for serving as a speaker, a consultant or an advisory board member. Philip R Cohen has received no research funding. Philip R Cohen is an employee of the University of California San Diego. Philip R Cohen owns no stocks or shares in any organization. Philip R Cohen owns no patents.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Philip R Cohen, MD, Department of Dermatology, University of California San Diego, 10991 Twinleaf Court, San Diego, CA 92131-3643, United States.
Telephone: +1-858-6578322
Received: June 26, 2016
Peer-review started: June 29, 2016
First decision: September 5, 2016
Revised: September 26, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 16, 2016

Drug-induced reticulate hyperpigmentation is uncommon. Including the patient described in this report, chemotherapy-associated reticulate hyperpigmentation has only been described in ten individuals. This paper describes the features of a woman with recurrent and metastatic breast cancer who developed paclitaxel-induced reticulate hyperpigmentation and reviews the characteristics of other oncology patients who developed reticulate hyperpigmentation from their antineoplastic treatment. A 55-year-old Taiwanese woman who developed reticulate hyperpigmentation on her abdomen, back and extremities after receiving her initial treatment for metastatic breast cancer with paclitaxel is described. The hyperpigmentation became darker with each subsequent administration of paclitaxel. The drug was discontinued after five courses and the pigment faded within two months. PubMed was searched with the key words: Breast, cancer, chemotherapy, hyperpigmentation, neoplasm, reticulate, tumor, paclitaxel, taxol. The papers generated by the search, and their references, were reviewed. Chemotherapy-induced reticulate hyperpigmentation has been described in four men and six women. Bleomycin, cytoxan, 5-fluorouracil, idarubacin, and paclitaxel caused the hyperpigmentation. The hyperpigmentation faded in 83% of the patients between two to six months after the associated antineoplastic agent was discontinued. In conclusion, chemotherapy-induced reticulate hyperpigmentation is a rare reaction that may occur during treatment with various antineoplastic agents. The hyperpigmentation fades in most individuals once the treatment is discontinued. Therefore, cancer treatment with the associated drug can be continued in patients who experience this cutaneous adverse event.

Keywords: Breast, Cancer, Chemotherapy, Hyperpigmentation, Neoplasm, Reticulate, Tumor, Paclitaxel, Taxol

Core tip: Chemotherapy-induced reticulate hyperpigmentation has been described in four men and six women being treated for either a hematologic malignancy or a solid tumor. Associated drugs included cytoxan (with or without idarubicin), paclitaxel, 5-fluorouracil and bleomycin. The skin lesions were usually asymptomatic and appeared as linear macular hyperpigmention that was lacy, net-like, or both on the patient’s back. The hyperpigmentation appeared within 3 d to 18 wk after starting the drug and faded within 2 to 6 mo after stopping the medication. Chemotherapy-induced reticulate hyperpigmentation did not require dose reduction or discontinuation of the associated antineoplastic treatment.