Keratoacanthomas arising in association with prurigo nodules in pruritic, actinically damaged skin

Wu, Timothy; Miller, Kristen; Cohen, David E.; Stein, Jennifer A.

doi:10.1016/j.jaad.2013.03.035

Cited by 20 publications

(20 citation statements)

References 25 publications

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“…For eruptive KAs, especially those associated with syndromes, systemic acitretin or other retinoids are first-line therapy, either as monotherapy or combined with surgery. 1 Several other therapies have been proposed, including cyclosporine, 13 intralesional corticosteroids, 14 and cryosurgery. 15 …”

Section: Discussionmentioning

confidence: 99%

Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

et al. 2017

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IMPORTANCETo our knowledge, there have been no previous reports of eruptive keratoacanthomas (KAs) in patients receiving pembrolizumab.OBJECTIVE To report the cases of 3 consecutive patients with pembrolizumab-induced eruptive KAs and their management. DESIGN, SETTING, AND PARTICIPANTS Case report study of 3 patients from 2 centers with pembrolizumab-treated cancer who all developed eruptive KAs. INTERVENTIONS All 3 patients had AK treatment with clobetasol ointment and intralesional triamcinolone; 2 patients also underwent open superficial cryosurgery.RESULTS Three consecutive patients with cancer, 2 men and 1 woman (median age, 83 years; range 77-91 years), experienced pembrolizumab-associated eruptive KAs. All patients presented with a sudden onset of multiple lesions on sun-exposed areas of their extremities after a median of 13 months (range, 4-18 months) of pembrolizumab therapy. On lesional biopsy, a lichenoid infiltrate was observed in the underlying dermis, predominantly composed of CD3 + T cells, scattered CD20 + B cells, and relatively few PD-1 + (programmed cell death 1-positive) T cells, an immunophenotypic pattern also observed in other cases of anti-PD-1-induced lichenoid dermatitis. Patients were treated with clobetasol ointment and intralesional triamcinolone, alone or in combination with open superficial cryosurgery. All KAs resolved in all patients, and no new lesions occurred during close follow-up. Pembrolizumab treatment was continued without disruption in all 3 cases, and all patients had complete responses of their primary cancers.CONCLUSIONS AND RELEVANCE Pembrolizumab is used in advanced melanoma, advanced non-small-cell lung cancer, and in head and neck cancer. A variety of dermatologic immune-related adverse events including maculopapular eruption, lichenoid reactions, pruritus, and vitiligo have been described. This case series demonstrates that pembrolizumab therapy may also be associated with eruptive KAs with characteristic dermal inflammation, which improved with corticosteroid treatment (topical and intralesional) alone or in combination with cryosurgery, allowing patients to continue therapy with pembrolizumab.

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Section: Discussionmentioning

confidence: 99%

Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

et al. 2017

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“…that corticosteroids may inhibit KA growth by inhibiting the hair growth cycle in the anagen phase (Sanders et al, 2002;Stenn, Paus, Dutton, & Sarba, 1993). The authors also suggested that these agents may inhibit the keratinocyte hyperplasia via interfering with the epidermal mitotic activity (Fisher & Maibach, 1971), DNA synthesis (Schwarz, Viaje, & Slaga, 1977) and the transcription of transforming growth factor (TGF-a) production in keratinocytes (Lee, Morhenn, Ilnicka, Eugui, & Allison, 1991 with KA whose lesions arose in the setting of prurigo nodularis also benefited from the therapy when intralesional corticosteroids were used in combination with systemic retinoids (Wu et al, 2013).…”

Section: Corticosteroidsmentioning

confidence: 99%

Intralesional therapy for the treatment of keratoacanthoma

Kiss

Avci

Bánvölgyi

et al. 2019

Dermatologic Therapy

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Keratoacanthoma (KA) is a common epidermal tumor that originates from the hair follicle of the skin. It is generally considered as a benign neoplasm, but in rare cases, it can also transform into squamous cell carcinoma. Although surgical excision with a safety margin is considered to be the gold standard treatment for most subtypes of KA, several other treatment options are also available. Intralesional therapy is one of these options, which could be cosmetically and functionally a better alternative to surgical removal, while it provides similar outcomes. It is more effective than topical treatments, yet fewer side effects may be seen than in systemic treatments. Based on the literature, the most commonly used intralesional agent is methotrexate, followed by 5‐fluorouracil and interferon alpha. Regardless of the advantages, which make intralesional therapy a desirable treatment alternative, guidelines for the intralesional treatment of KA are not yet established. A histopathological confirmation before the start of treatment is still recommended to prevent any possible misdiagnosis of KA for SCC. In our present study, we set out to review the current state of the art of the intralesional treatment of KA.

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“…One case series found that KA-type SCC co-occurred within a field of prurigo nodules in 7 elderly patients with diffuse actinic skin damage, which raised concern for the clinical differentiation of these lesions. 9 Furthermore, chronic prurigo may increase risk for SCC, as one case series reported SCC occurring within 2 long-standing biopsy-proven prurigo nodules. 10 Although case series suggest that PN may contribute to the development KAtype SCC, future studies are needed to determine if adequate resolution of PN nodules reduces subsequent risk of KA-type SCC at the site of prior PN.…”

Section: Discussionmentioning

confidence: 99%