Keratoacanthoma Treated with Methotrexate

Kestel, John L.

doi:10.1001/archderm.1973.01620260067028

Cited by 19 publications

(8 citation statements)

References 5 publications

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“…Overall, the most commonly used method of treatment for multiple keratoacanthomas involves medical therapy. Systemic chemotherapies, such as methotrexate, have been used on destructive keratoacanthomas, and 5‐fluorouracil (5‐FU) has been successful in treating keratoacanthomas unresponsive to methotrexate 12,13 . To avoid systemic toxicities, intralesional injection of various chemotherapies, such as methotrexate, 5‐fluorouracil, and interferon alfa‐2a, into larger isolated lesions has been used successfully, in addition to newer 14–16 topical immune modulators, such as Imiquimod 17 …”

Section: Discussionmentioning

confidence: 99%

Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas

Feldman

Maize

2007

Int J Dermatology

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A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas. Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL (normal, < 200 mg/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple kerat...

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Section: Discussionmentioning

confidence: 99%

Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas

Feldman

Maize

2007

Int J Dermatology

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“…Eruptive keratoacanthomas confined to a man's forehead following herpes zoster infection also cleared with isotretinoin 19 . There have been individual reports of partial therapeutic response to isotretinoin, 20 etretinate, 21–23 methotrexate 24,25 and ranitidine 14 …”

Section: Discussionmentioning

confidence: 99%

Grzybowski's generalized eruptive keratoacanthoma: Remission with cyclophosphamide

Oakley¹,

2005

Aust J Dermatology

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A 57-year-old woman presented with intensely pruritic generalized eruptive keratoacanthomas affecting cutaneous and mucosal surfaces (Grzybowski syndrome). She derived marginal benefit from anti-pruritic agents, acitretin and methotrexate. However, cyclophosphamide 100 mg daily for 1 month followed by 3 months at 200 mg daily resulted in remarkable improvement and eventual remission without further treatment. The disease resulted in severe ectropion of upper and lower eyelids bilaterally. Two years after the onset of her disease, the lower lid ectropions were repaired using skin grafting. There was no evidence for papillomavirus infection.

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“…24 Melton et al 25 successfully used intralesional methotrexate to treat 9 patients with large or strategically located KAs. Grob et al, 26 in 1993, used intralesional interferon alfa-2a to treat 6 large KAs, with regression in 5 of the 6 lesions noted after 3 to 7 weeks.…”

Section: Discussionmentioning

confidence: 99%