title: Palifermin-associated papular eruption.
abstract: BACKGROUND
  Palifermin is a recombinant human keratinocyte growth factor that is used to reduce the duration and severity of oral mucositis in patients undergoing hematopoietic stem cell transplantation after myelotoxic therapy. Cutaneous adverse reactions associated with keratinocyte growth factor are reported to be rash, pruritus, and erythema.
  
  
  METHODS
  After receiving palifermin following autologous hematopoietic stem cell transplantation and treatment with melphalan, a patient developed erythema and lichenoid papules that were distributed primarily in intertriginous areas. A biopsy specimen of the papules showed a striking resemblance to verrucae, but in situ hybridization studies were negative for human papillomavirus. Immunohistochemical staining with antibodies to Ki-67 and cytokeratin 5/6 showed increased keratinocyte proliferation in lesional skin.
  
  
  CONCLUSIONS
  After treatment with palifermin, a papular eruption clinically resembling lichen planus or plane warts, with histologic features of verruca plana, and intertriginous erythema may occur. In this case, neither eruption required treatment, and spontaneous resolution was observed over days to weeks. Histopathologic staining patterns of Ki-67 and cytokeratin 5/6 may be useful in identifying adverse reactions to palifermin therapy.
authors.affiliation: Department of Dermatology, Yale University, New Haven, CT, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: King
authors.forename: Eleanor
authors.initials: E
authors.lastname: Knopp
authors.forename: Anjela
authors.initials: A
authors.lastname: Galan
authors.forename: Gerard
authors.initials: G
authors.lastname: Nuovo
authors.forename: Robert
authors.initials: R
authors.lastname: Tigelaar
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNiff
mesh_terms: D000368:Aged; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology*; D051523:Fibroblast Growth Factor 7 / Q000009:adverse effects*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D011994:Recombinant Proteins; D013280:Stomatitis / Q000188:drug therapy / Q000209:etiology
chemical_list: C496453:FGF7 protein, human; D011994:Recombinant Proteins; D051523:Fibroblast Growth Factor 7