Eruptive Keratoacanthoma in a 59-year-old Female with Chronic Kidney Disease: A Case Report and Review of Treatment Approaches

Main Article Content

Mitchell Taylor
Amelia Pham
Michaela Clausen
Kamruz Darabi

Keywords

generalized eruptive keratoacanthoma of Grzybowski, multiple keratoacanthoma, GEKA, skin cancer, eruptive squamous atypia, keratoacanthoma

Abstract

We present the case of a 59-year-old female with multiple squamous neoplasms, including keratoacanthomas, well-differentiated squamous cell carcinomas, and prurigo nodules. The patient developed dozens of lesions progressively over the course of a few years. Keratoacanthomas can be challenging to distinguish from well-differentiated squamous cell carcinomas; this and the presence of numerous lesions poses a major challenge with diagnosing and managing this condition. The pathogenesis, challenges with diagnosis and management, and treatment regimens for eruptive keratoacanthomas are further discussed.

References

1. Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. British journal of dermatology (1951). 2021;185(3):487-498. doi: 10.1111/bjd.20389.

2. Ko CJ, MD. Keratoacanthoma: Facts and controversies. Clinics in dermatology. 2010;28(3):254-261. doi: 10.1016/j.clindermatol.2009.06.010.

3. Ghadially f. The role of the hair follicle in the origin and evolution of some cutaneous neoplasms of man and experimental animals. Cancer. 1961;14(4):801-816. doi: 10.1002/1097-0142(199007/08)14:43.0.CO;2-K.

4. Calonje E, McKee PH. McKee's Pathology of the Skin. Fifth edition ed. ; 2020.

5. Havenith R, de Vos L, Fröhlich A, et al. Grzybowski’s Generalized Eruptive Keratoacanthomas in a Patient with Terminal Kidney Disease—An Unmet Medical Need Equally Ameliorated by Topical Imiquimod Cream and Lapacho Tea Wraps: A Case Report. Dermatol Ther (Heidelb). 2021;11(2):625-638. doi: 10.1007/s13555-021-00502-2.

6. Kwiek, Bartlomiej, MD, PhD, Schwartz, Robert A., MD, MPH. Keratoacanthoma (KA): An update and review. Journal of the American Academy of Dermatology. 2015;74(6):1220-1233. doi: 10.1016/j.jaad.2015.11.033.

7. Mascitti H, De Masson A, Brunet-Possenti F, et al. Successful Treatment of Generalized Eruptive Keratoacanthoma of Grzybowski with Acitretin. Dermatol Ther (Heidelb). 2019;9(2):383-388. doi: 10.1007/s13555-019-0287-0.

8. Yell JA. Grzybowski's Generalized Eruptive Keratoacanthoma. Journal of the Royal Society of Medicine. 1991;84:170-171.

9. Nofal A, Assaf M, Nofal E, Alradi M. Generalized eruptive keratoacanthoma: proposed diagnostic criteria and therapeutic evaluation. Journal of the European Academy of Dermatology and Venereology. 2014;28(4):397-404. doi: 10.1111/jdv.12226.

10. Consigli JE, GonzAlez ME, Morsino R, et al. Generalized eruptive keratoacanthoma (Grzybowski variant). British journal of dermatology (1951). 2000;142(4):800-803. doi: 10.1046/j.1365-2133.2000.03430.x.

11. Que SKT, Compton LA, Schmults CD. Eruptive squamous atypia (also known as eruptive keratoacanthoma): Definition of the disease entity and successful management via intralesional 5-fluorouracil. Journal of the American Academy of Dermatology. 2019;81(1):111-122. doi: 10.1016/j.jaad.2018.10.014.

12. Cribier B, Asch P, Grosshans E. Differentiating squamous cell carcinoma from keratoacanthoma using histopathological criteria: Is it possible? A study of 296 cases. Dermatology (Basel). 1999;199(3):208-212.

13. Kossard S, Tan K, Choy C. Keratoacanthoma and Infundibulocystic Squamous Cell Carcinoma. The American journal of dermatopathology. 2008;30(2):127-134. doi: 10.1097/DAD.0b013e318161310c.

14. Slater M, Barden JA. Differentiating keratoacanthoma from squamous cell carcinoma by the use of apoptotic and cell adhesion markers. Histopathology. 2005;47(2):170-178. doi: 10.1111/j.1365-2559.2005.02155.x.

15. Popkin GL, Brodie SJ, Hyman AB, Andrade R, Kopf AW. A Technique of Biopsy Recommended for Keratoacanthomas. Archives of dermatology (1960). 1966;94(2):191-193. doi: 10.1001/archderm.1966.01600260083010.

16. Nofal A, Assaf M, Ghonemy S, Nofal E, Yosef A. Generalized eruptive keratoacanthoma: a diagnostic and therapeutic challenge. International journal of dermatology. 2015;54(2):160-167. doi: 10.1111/ijd.12308.

17. Clark MA, Guitart J, Gerami P, Marks BR, Amin S, Yoo SS. Eruptive keratoacanthomatous atypical squamous proliferations (KASPs) arising in skin graft sites. JAAD Case Reports. 2015;1(5):274-276. doi: 10.1016/j.jdcr.2015.06.009.

18. Street ML, White JW, Gibson LE. Multiple keratoacanthomas treated with oral retinoids. Journal of the American Academy of Dermatology. 1990;23(5):862-866. doi: 10.1016/0190-9622(90)70305-2.

19. Sanders S, Busam KJ, Halpern AC, Nehal KS. Intralesional Corticosteroid Treatment of Multiple Eruptive Keratoacanthomas: Case Report and Review of a Controversial Therapy. Dermatologic surgery. 2002;28(10):954-958. doi: 10.1046/j.1524-4725.2002.02069.x.

20. West L, Ayoade K, Vandergriff T, Nijhawan RI. Multiple reactive keratoacanthomas treated with zinc oxide wraps and intralesional corticosteroids. JAAD Case Reports. 2018;4(7):701-704. doi: 10.1016/j.jdcr.2018.06.005.

21. Gray RJ, Meland NB. Topical 5-fluorouracil as primary therapy for keratoacanthoma. Annals of plastic surgery. 2000;44(1):82-85. doi: 10.1097/00000637-200044010-00015.