Unusual Skin Toxicity after a Chemotherapic Combination

A 66 year-old Caucasian patient presented to our attention complaining for an heliotrope rash and large diffuse erythematous itching with pustular-like lesions on his trunk, upper arms, involving the upper gluteus, with a yellowish necrotic like surface (Figure 1A,1B). Brown-to-purple lesions were also present on the right side of his back associated to muscle weakness. His personal medical history was positive for diabetes, hypertension and a 14 months history of squamous cell carcinoma of the lung. After 45 days of a sequential chemotherapic combination, with carboplatin/gemcitabine/taxotere/ bevacizumab regimen the patient referred the onset of the skin reaction.