Generalized eruptive keratoacanthomas of Grzybowski (case report)

The article presents a brief review of the literature about clinical manifestations, modern methods of diagnosticsand treatment of an extremely rare disease – generalized eruptive keratoacanthomas of Grzybowski. The disease is characterized  by the appearance of hundreds or thousands of generalized itchy nodules on the skin of the face, trunk, limbs, genitals, oral mucosa and larynx within a short time. The disease develops at the age of over 40, has a recurrent  course, spontaneous  involution of individual elements with the formation of areas of depigmentation or atrophic scars is possible. The authors describe a case of their own clinical care of generalized eruptive keratoacanthomas of Grzybowski in a 50-year-old patient who consulted a dermatovenerologist at the clinic of the Ural Research Institute of Dermatovenerology and Immunopathology.The duration  of the disease at the time of visit to a doctor was 2,5 years, its occurrence was preceded by repeated visits to countries with excessive insolation,  which can be considered as an etiological factor in the development of the disease. The diagnosis was first suspected at a boarddermatovenerologists based on the clinical picture of the disease and subsequently verified by the data of a pathomorphological examination  of the biopsy of the affected skin.The effectiveness of the use of aromatic retinoids in the treatment  of generalized eruptive keratoacanthomas of Grzybowski is shown and the side effects that developed in the patient with an independent increase in the dose of acitretin to 70 mg/day are given. The article states the extremely rare occurrence of this disease, as evidenced by the above clinical case, diagnosed for the first time in more than 90 years of the institute's existence. The importance of consolidating the clinical experience of several leading dermatovenerologists for the diagnostics of generalized eruptive keratoacanthomas of Grzybowski is emphasized.

1. Kungurov N. V. Skin diseases. Monograph (atlas). Yekaterinburg: UrNIIDViI, 2014. Р. 176.

2. Malishevskaya N. P., Kokhan M. M., Sokolova A. V. i soavt. Dermato-oncology (malignant neoplasms of the skin, primary lymphomas of the skin): Atlas / Pod obshch. red. N. V. Kungurova. Yekaterinburg: Izd-vo Ural. un-ta, 2016. Р. 168.

3. Kuklin I. A., Keniksfest Yu. V., Volkova N. V. i soavt. Pringle-Bourneville disease: diagnostics at the intersection of disciplines // Sovremennyye problemy dermatovenerologii, immunologii i vrachebnoy kosmetologii. 2010; 4 (4): 55-52.

4. Kuklin I. A., Kokhan M. M., Demidov S. M. i soavt. Clinical case of multiple tumor-like rashes in the practice of a dermatovenerologist // Ural'skiy meditsinskiy zhurnal. 2018; 5 (160): 116-118.

5. Kuklin I. A., Kokhan M. M., Demidov S. M. i soavt. Nodular lesions of the skin of the face and upper extremities: clinical and pathomorphological diagnostics (a case from clinical practice) // Ural'skiy meditsinskiy zhurnal. 2018; 10 (165): 141-144.

6. Molochkov V. A., Kuntsevich Zh. S., Bobrov M. A. i soavt. Eruptive keratoacanthoma of Grzhebowski type // Al'manakh klinicheskoy meditsiny. 2014; 34: 36-41.

7. Kuntsevich Zh. S., Molochkova Yu. V., Bobrov M. A. i soavt. Acitretin in the treatment of eruptive keratoacanthoma of the Grzhebowski type // Al'manakh klinicheskoy meditsiny. 2016; 44 (1): 96-102.

8. Lane Anzalone C., Cohen P. R. Generalized eruptive keratoacanthomas of Grzybowski // International Journal of Dermatology. 2014; 53 (2): 131-136. DOI: 10.1111/ijd.12318.

9. Parry F., Saunière D., Huertas D. L. et al. Kératoacanthomesgénéralisés multiples de Grzybowski: suivi d’un cascliniquesur 11 ans // Аnnales de chirurgieplastiqueesthétique. 2016. DOI: 10.1016/j.anplas.2016.06.006.

10. Havenith R., Vos L., Frohlich A. et al. Grzybowski’s Generalized Eruptive Keratoacanthomas in a Patientwith Terminal Kidney Disease – An Unmet Medical Need Equally Ameliorated by Topical Imiquimod Cream and Lapacho Tea Wraps: A Case Report // Dermatology and Therapy. 2021; 11: 625-638.

11. Molochkov V. A., Molochkov A. V., Sukhova T. Ye. i soavt. Local photodynamic therapy of keratoacanthoma // Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney. 2012; 4: 21-24.

12. Molochkov V. A., Molochkova Yu. V. Dermatooncology. Treatment. M.: Prakticheskaya meditsina, 2018. Р. 328.

13. Mlacker S., Kaw U., Maytin E. V. Use of photodynamic therapy and acitretin in generalized eruptive keratoacanthoma of Grzybowski // JAAD Case Rep. 2017; 3 (5): 457-459. DOI: 10.1016/j.jdcr.2017.06.013.

14. Mascitti H., Masson A., Brunet-Possenti F. et al. Successful Treatment of Generalized Eruptive Keratoacanthoma of Grzybowski with Acitretin // Dermatology and Therapy. 2019; 9: 383-388.