Dermatological manifestations of palifermin therapy

Abstract

I read with great interest the recent article by Yazbeck et al in a recent issue of your esteemed journal. The article provides for highly interesting reading. Palifermin clearly has a definite benefit in oncology. However, its clinical use may be associated with the development of a number of dermatological side effects. For instance, Kaloyannidis et al have reported the development of mucosal hyperpigmemtation accompanied by allodynia following the clinical use of palifermin. Similarly hyperkeratosis, hyperplastic gingivitis and macroglossia may occur secondary to palifermin administration. Palifermin use may also be associated with the development of lichenoid lesions that are primarily seen in the intertriginous areas. These lesions surprisingly stain positive with antibodies to Ki-67 and show histological features similar to verruca plana. Palifermin may also trigger over expression of filaggrin resulting in the development of flexural hyper pigmentation.

I read with great interest the recent article by Yazbeck et al. in a recent issue of your esteemed journal.¹ The article provides for a highly interesting reading. Palifermin clearly has a definite benefit in oncology. However, its clinical use may be associated with the development of a number of dermatological side effects. For instance, Kaloyannidis et al. have reported the development of mucosal hyperpigmemtation accompanied by allodynia following the clinical use of palifermin.²

Similarly hyperkeratosis, hyperplastic gingivitis and macroglossia may occur secondary to palifermin administration.^3,4 Palifermin use may also be associated with the development of lichenoid lesions that are primarily seen in the intertriginous areas.⁵ These lesions surprisingly stain positive with antibodies to K_i-67 and show histological features similar to verruca plana. Palifermin may also trigger overexpression of filaggrin resulting in the development of flexural hyper pigmentation.⁶

Acanthosis nigricans is another common dermatological side effect of palifermin administration.⁷ Palifermin may also cause palmar-plantar erythrodysesthesia.⁸ One needs to be careful in patients with immunocompromised states such as HIV infection and coexisting malignancies such as Hodgkin’s lymphoma, as palifermin may actually cause re-activation of infections such as HPV.⁹ Rarely, palifermin use is associated with the development of anaphylactic reactions.¹⁰

Clearly, palifermin is associated with a number of dermatological side effects. Physicians should be aware of the potential development of these side effects when using palifermin for their patients with chronic graft-vs.-host disease.