History: This lady had cytotoxic therapy for a lymphoma which included Bleomycin in the regime. Initial red pruritic linear lesions are followed by pigmentation which slowly resolves over months. The incidence of the complication varies between series from 10-60% but appears to be dosage dependent. The curious linear pigmentation is called flagellate hyperpigmentation. Clinically it resembles pigmentation following a phytophototoxic reaction from a plant sap and sunlight. An article on other chemotherapy induced drug reactions can be viewed on Dermnet