title: Palifermin-induced flexural hyperpigmentation: a clinical and histological study of five cases.
abstract: Palifermin is a human keratinocyte growth factor that is efficacious in reducing duration and severity of oral mucositis during autologous haematopoietic stem-cell transplantation for haematological cancer as well as chemotherapy for colorectal cancers. We report the clinical and histological characteristics of a series of five patients who developed flexural hyperpigmentation after treatment with palifermin. All patients showed ill-defined symmetrical hyperpigmented papillomatous plaques with slight erythema in the skin folds, especially affecting axillary and inguinal areas. The most striking histological finding was the thickened granular layer in all patients. We demonstrate that filaggrin, an essential component in the terminal differentiation of the epidermis, was upregulated in these cases. Palifermin-induced flexural hyperpigmentation is a newly defined clinical and histological entity. The possible aetiology is discussed.
authors.affiliation: Department of Dermatology, Radbound University, Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. L.Sibelt@derma.umcn.nl
authors.forename: L A G
authors.initials: LA
authors.lastname: Sibelt
authors.forename: N
authors.initials: N
authors.lastname: Aboosy
authors.forename: W J F M
authors.initials: WJ
authors.lastname: van der Velden
authors.forename: N M A
authors.initials: NM
authors.lastname: Blijlevens
authors.forename: W A M
authors.initials: WA
authors.lastname: Blokx
authors.forename: M M B
authors.initials: MM
authors.lastname: Seyger
mesh_terms: D001365:Axilla / Q000473:pathology; D005260:Female; D051523:Fibroblast Growth Factor 7 / Q000009:adverse effects*; D000091344:Filaggrin Proteins; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013280:Stomatitis / Q000517:prevention & control
chemical_list: C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D051523:Fibroblast Growth Factor 7