Palifermin-associated papular eruption.
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.
King
Brett
B
Department of Dermatology, Yale University, New Haven, CT, USA.
Knopp
Eleanor
E
Galan
Anjela
A
Nuovo
Gerard
G
Tigelaar
Robert
R
McNiff
Jennifer
J
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
C496453:FGF7 protein, human; D011994:Recombinant Proteins; D051523:Fibroblast Growth Factor 7