Serpentine supravenous hyperpigmentation (SSH) refers to a hyperpigmented eruption overlying the vasculature at or around a site where an intravenous (IV) chemotherapeutic agent has been administered. It may begin as erythematous, linear patches overlying vessels and then progress into hyperpigmented streaks over days to weeks.

The most common site is the forearm near an injection site. SSH may appear within days to years after chemotherapy. The most common causative agent is 5-fluorouracil, although other agents have been implicated as well, including taxanes (ie, docetaxel), vinca alkaloids (ie, vinorelbine, vincristine), alkylating agents (ie, carboplatin, oxaliplatin, cyclophosphamide), antitumor antibiotics (ie, actinomycin, bleomycin), anthracyclines (ie, epirubicin, daunorubicin, doxorubicin), proteasome inhibitors (ie, bortezomib), or a combination of these agents.