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Case Reports
. 2009 Feb;145(2):179-82.
doi: 10.1001/archdermatol.2008.548.

Palifermin-associated papular eruption

Brett King  1 , Eleanor Knopp, Anjela Galan, Gerard Nuovo, Robert Tigelaar, Jennifer McNiff
Affiliations
Case Reports

Palifermin-associated papular eruption

Brett King et al. Arch Dermatol. 2009 Feb.

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.

Observations: 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.

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Figures

Figure 1
Figure 1
Clinical appearance on initial evaluation revealed erythema and a papular eruption in a predominantly intertriginous distribution (A); 1 week later, the eruption was largely resolved (B).
Figure 2
Figure 2
Skin biopsy specimen of an early lesion. A, Hematoxylin-eosin staining shows papillated epidermal hyperplasia, hypergranulosis, and laminated hyperkeratosis (original magnification ×40). B, Immunostaining with Ki-67, a proliferation marker, shows dramatically increased labeling of basilar and suprabasilar keratinocytes (original magnification ×40). C, Immunostaining with cytokeratin 5/6 shows activation of the entire basal layer and stratum spinulosum (original magnification ×40).
See this image and copyright information in PMC

References

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