August 1992

Cutaneous Reactions to Granulocyte-Monocyte Colony-Stimulating Factor

Author Affiliations

From the Department of Dermatology (Drs Mehregan, Fransway, and Leiferman) and the Division of Medical Oncology (Dr Edmonson), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Arch Dermatol. 1992;128(8):1055-1059. doi:10.1001/archderm.1992.01680180049004

• Background and Design.—  Granulocyte-monocyte colonystimulating factor (GMCSF) is a hematopoietic growth factor that stimulates the proliferation and differentiation of neutrophils, eosinophils, and monocytes. We reviewed the cutaneous reactions that developed in 26 patients who received GMCSF as part of a chemotherapeutic protocol.

Results.—  Fourteen patients developed immediate localized angioedematous reactions at the subcutaneous GMCSF injection site, and 21 developed generalized cutaneous reactions. Four biopsy specimens were obtained from three patients who had generalized erythrodermic reactions. All specimens showed perivascular and periadnexal lymphocytic inflammation in the dermis, and two showed perivascular and periadnexal eosinophilia. Staining for eosinophil granule major basic protein showed infiltration by eosinophils and extracellular deposition of major basic protein in three specimens from two patients with eosinophilia. Extracellular deposition of neutrophil elastase and mast cell tryptase was minimal.

Conclusions.—  Cutaneous reactions are prominently associated with GMCSF administration. Eosinophils, known to release toxic products after being activated, may have a role in these skin reactions through stimulation by GMCSF.(Arch Dermatol. 1992;128:1055-1059)