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.Citation1 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.Citation2
Similarly hyperkeratosis, hyperplastic gingivitis and macroglossia may occur secondary to palifermin administration.Citation3,Citation4 Palifermin use may also be associated with the development of lichenoid lesions that are primarily seen in the intertriginous areas.Citation5 These lesions surprisingly stain positive with antibodies to Ki-67 and show histological features similar to verruca plana. Palifermin may also trigger overexpression of filaggrin resulting in the development of flexural hyper pigmentation.Citation6
Acanthosis nigricans is another common dermatological side effect of palifermin administration.Citation7 Palifermin may also cause palmar-plantar erythrodysesthesia.Citation8 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.Citation9 Rarely, palifermin use is associated with the development of anaphylactic reactions.Citation10
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.
References
- Yazbeck R, Howarth GS, Borges L, Geier MS, Smith CL, Davidson GP, Butler RN. Non-invasive detection of a palifermin-mediated adaptive response following chemotherapy-induced damage to the distal small intestine of rats.
- Kaloyannidis P, Papalexandri A, Papaemanouil E, Papaioannou M, Sakellari I. Reversible painful oral mucosal hyperpigmentation following palifermin administration. Acta Haematol 2010; 124:185 - 7; http://dx.doi.org/10.1159/000318835; PMID: 20962520
- Lerman MA, Treister NS. Generalized white appearance of the oral mucosa. Hyperkeratosis secondary to palifermin. J Am Dent Assoc 2010; 141:867 - 9; PMID: 20592407
- Grzegorczyk-Jaźwińska A, Kozak I, Karakulska-Prystupiuk E, Rokicka M, Ganowicz E, Dwilewicz-Trojaczek J, et al. Transient oral cavity and skin complications after mucositis preventing therapy (palifermin) in a patient after allogeneic PBSCT. Case history. Adv Med Sci 2006; 51:Suppl 1 66 - 8; PMID: 17460832
- King B, Knopp E, Galan A, Nuovo G, Tigelaar R, McNiff J. Palifermin-associated papular eruption. Arch Dermatol 2009; 145:179 - 82; http://dx.doi.org/10.1001/archdermatol.2008.548; PMID: 19221263
- Sibelt LA, Aboosy N, van der Velden WJ, Blijlevens NM, Blokx WA, Seyger MM. Palifermin-induced flexural hyperpigmentation: a clinical and histological study of five cases. Br J Dermatol 2008; 159:1200 - 3; PMID: 18795935
- Lee M, Grassi M. Acanthosis nigricans in a patient treated with palifermin. Cutis 2010; 86:136 - 7; PMID: 21049730
- Keijzer A, Huijgens PC, van de Loosdrecht AA. Palifermin and palmar-plantar erythrodysesthesia. Br J Haematol 2007; 136:856 - 7; http://dx.doi.org/10.1111/j.1365-2141.2007.06509.x; PMID: 17341273
- Schroeder T, Zohren F, Saure C, Kobbe G, Haas R. Palifermin, a recombinant human keratinocyte growth factor, triggers reactivation of anogenital human papillomavirus infection in a HIV-positive patient with diffuse large cell B-cell non-Hodgkin lymphoma. Bone Marrow Transplant 2009; 44:823 - 4; http://dx.doi.org/10.1038/bmt.2009.81; PMID: 19421177
- Palifermin: anaphylaxis, oedema and hyperpigmentation. Sucking ice is safer for preventing oral mucositis. Prescrire Int 2009; 18:257; PMID: 20050200