42445 Eruptive Keratoacanthoma of Grzybowski in an African American Female

Document Type

Conference Proceeding

Publication Date

9-19-2023

Publication Title

J Am Acad Dermatol

Abstract

A 62-year-old African American female patient without significant past medical history was referred for diffuse pruritic hyperkeratotic papules for the past two years. She was developing more lesions over time, involving the head, neck, trunk, and extremities with refractory pruritus. No new medication was started at time of onset of lesions. There was no family history of such disease. On examination, her scalp, neck, and back were covered with innumerable dome-shaped, keratotic papules in both photodistributed and non-photodistributed areas (inguinal folds, buttocks). She had ectropion of her bilateral eyelids. Numerous skin biopsies of separate papules (>10) demonstrated atypical squamous proliferations, some of which were more clearly defined invasive, well-differentiated squamous cell carcinomas. CBC and CMP were within normal limits. Given the patient’s clinical presentation and pathology findings, she was diagnosed with eruptive keratoacanthoma of Grzybowski (GEKA). GEKA is a rare variant of keratoacanthoma. First described in the 1950s, its pathogenesis remains unclear. It is distinct from other forms of induced KA (e.g. drug, trauma) and is distinguished from other KA syndromes by its lack of inheritance, onset in late adulthood, and generalized distribution involving hundreds of lesions consistent with keratoacanthomas. Variable criteria include masked facies, mucosal lesions, ectropion, and crateriform nodules. GEKA is notably refractory to treatment. Retinoids are the most common agents trialed and can be combined with methotrexate. Other treatments include cyclophosphamide, photodynamic therapy, and H2 blockers. To our knowledge, this is the only case documenting this rare condition in a patient with skin of color.

Volume

89

Issue

3

First Page

AB45

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