Conflict of interest: none declared.
Viewpoints in Dermatology ● Correspondence
Generalized eruptive keratoacanthoma of Grzybowski: strict diagnostic criteria are still lacking
Article first published online: 14 JUN 2013
© 2013 British Association of Dermatologists
Clinical and Experimental Dermatology
Volume 39, Issue 1, pages 87–88, January 2014
How to Cite
Nofal, A. and Nofal, E. (2014), Generalized eruptive keratoacanthoma of Grzybowski: strict diagnostic criteria are still lacking. Clinical and Experimental Dermatology, 39: 87–88. doi: 10.1111/ced.12178
- Issue published online: 17 DEC 2013
- Article first published online: 14 JUN 2013
- Manuscript Accepted: 18 FEB 2013
We read with interest the article by Davies and Davies on multiple eruptive keratoacanthoma (KA) entitled ‘A widespread, itchy papular eruption’, recently published in Clinical and Experimental Dermatology. In this article, Davies and Davies have described a case of multiple eruptive KA, and classified it as KA of Witten and Zak. However, we do not agree with this concept, and believe that this case is more consistent with the diagnosis of generalized eruptive keratoacanthoma (GEKA) of Grzybowski.
As described, the patient was elderly (81 years), presented with hundreds of erythematous small follicular papules (< 5 mm in size) with a central keratotic plug, and had only two nonulcerating larger nodules. The distribution of the lesions was generalized, itching was a prominent feature, and the course was progressive. Based on the available literature,[2-5] these features were always present in the reported cases of GEKA, and seem to be consistent features necessary for the diagnosis of the disease (Fig. 1). Other reported features, such as mucosal involvement, ectropion and masked facies, may be considered as variable features. Moreover, the absence of either a positive family history or of multiple large, noduloulcerative and destructive tumours argues against the diagnosis of multiple KA of Witten and Zak in this case, and helps to differentiate between these two types of KA (Table 1).
|Feature||GEKA||Witten and Zak|
|Type||Small follicular papules||Multiple large nodules and small follicular papules|
|Number||Hundreds to thousands||Less numerous|
|Scarring||Positive or negative||Positive|
In addition, many cases described in the literature under the term ‘multiple eruptive keratoacanthoma’ do not fit well with the characteristic clinical features and course of GEKA as described by Grzybowski, resulting a considerable overlap and confusion between both terms. We therefore believe that developing strict diagnostic criteria for GEKA (Table 2) is important to define the disease precisely, to simplify the diagnosis, and to avoid missing cases and overlapping with other types of multiple KA. We also suggest that the use of the word ‘eruptive’ should be restricted only to GEKA to differentiate it from the other presentations of multiple KA.
|Consistent*||Patients are adults, usually fifth to seventh decade of life|
|Severe and persistent itching|
|Generalized eruption of hundreds to thousands of small follicular papules, with or without a keratotic centre|
|Histopathology consistent with KA|
|Nodules with central crater, typical of solitary KA|