Chronic involuting relapsing keratoacanthoma with grouping tendency of lesions in seven staggering cases
Keywords:
involuting, relapsing, keratoacanthoma, chronic, CIRKAAbstract
Background There are case reports in the medical literature showing some patients has recurrent keratoacanthoma in selected region and given different names such as chronic keratoacanthoma serpiginous, eruptive keratoacanthoma centerifugum and involuting keratoacanthoma. Objective To report seven patients with keratoacanthoma who had recurrent relapsing and involuting keratoacanthoma in selected body regions and to suggest a covering reprehensive name for this specific medical condition. Methods This is cross sectional descriptive study that was carried out during the period from 2013-2020 where all patients with keratoacanthoma were collected and among them the recurrent involuting keratoacanthoma were isolated. Full demographic and clinical examination was done. Skin biopsies were performed for histopathological evaluation. Results Forty-five patients with keratoacanthoma were described with Fitzpatrick skin type III, IV among them seven (15.5%) male patients with chronic involuting relapsing keratoacanthoma (CIRKA) were detected, their ages ranged from 25-60 years with a mean of 50 years with negative family history. All had chronic picture with a round of 3-4 years duration. Patients gave story of old and new lesions appearing on the sites. The sites of lesions were on the dorsa of hands in three patients with one patient had in addition chest involvement. While the other four patients had their lesions on the legs apart of one patient had in addition lesions on the face. In all patients, the lesions on the sun exposed sites including face, hands and legs. Also, all patients and on all sites showed different stages of lesion maturation, early umblicated papules and nodules, then small and large plaques, and large tumor size some with characteristic keratoacanthoma with crateriform. All patients had grouping of their lesions in well selected sites. In addition some had atrophic areas which were the sites of involution. Histopathological evaluation demonstrated a picture of keratoacanthoma in all patients. Conclusion All patients showed features of recurrent involuting relapsing keratoacanthoma on well-defined areas. The histopathology was that of keratoacanthoma and all cases are not part of syndrome. As literature described this entity by different names; hence we suggest the name chronic relapsing involuting keratoacanthoma (CIRKA) as representative new informative name.References
Tisack A, Fotouhi A, Fidai C, Friedman B j., Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Br J Dermatol [Internet]. 2021;185(3):487–98.
Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.20389
Strieth S, Hartschuh W, Pilz L, Fusenig NE. Carcinoma-like vascular density in atypic keratoacanthoma suggests malignant progression. Br J Cancer [Internet]. 2002;87(11):1301–7.
Available from: https://www.nature.com/articles/6600622
Litaiem N, Khammouma F, Mrad M, Bacha T, Belhadj Kacem L, Zeglaoui F. Multiple keratoacanthomas of FERGUSON‐SMITH type. Clin Case Rep. [Internet]. 2022;10(10).
Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.6429
Grzybowski’s Generalized Eruptive Keratoacanthomas in a Patient with Terminal Kidney Disease—An Unmet Medical Need Equally Ameliorated by Topical Imiquimod Cream and Lapacho Tea Wraps: A Case Report | SpringerLink [Internet]. [cited 2022 Nov 25]. Available from: https://link.springer.com/article/10.1007/s13555-021-00502-2
Ambur A, Clark A, Nathoo R. An Updated Review of the Therapeutic Management of Keratoacanthomas. J Clin Aesthet Dermatol. 2022;15(11):30–6.
Schwartz RA. Keratoacanthoma. J Am Acad Dermatol [Internet]. 1994;30(1):1–19.
Available from: https://www.sciencedirect.com/science/article/pii/S019096229470001X
Esser AC, Abril A, Fayne S, Doyle JA. Acute development of multiple keratoacanthomas and squamous cell carcinomas after treatment with infliximab. J Am Acad Dermatol [Internet]. 2004;50(5):75–7.
Available from: https://www.sciencedirect.com/science/article/pii/S019096220304310X
Shaw JC, Storrs FJ, Everts E. Multiple keratoacanthomas after megavoltage radiation therapy. J Am Acad Dermatol. 1990;23(5):1009–11.
Available from: https://www.jaad.org/article/0190-9622(90)70324-B/abstract
Xiao H, Hooper PB, Umphress BA, Wolverton JE. Keratoacanthoma centrifugum marginatum. Dermatol Online J. 2021;27(3).
Available from: https://escholarship.org/uc/item/5vp5f7bq
Mangas C, Bielsa I, Ribera M, Fernández-Figueras MT, Ferrándiz C. A Case of Multiple Keratoacanthoma Centrifugum Marginatum. Dermatol Surg. 2004;30(5):803–6.
Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-4725.2004.30225.x
Zargaran M, Baghaei F. A clinical, histopathological and immunohistochemical approach to the bewildering diagnosis of keratoacanthoma. J Dent (Shiraz). 2014;15(3):91–7.
Sharqiue KE, Noaimi AA. Podophyllin 25% as alternative Effective Topical therapy for Keratoacanthoma. Global Dermatol. 2014; 1(1): 21-3.
Feldman RJ, Maize JC. Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas. Int J Dermatol. 2007;46(1):77–9.
Kolmodin A, Pandeya NP, Olsen CM, Dusingize JC, Whiteman DC, Claeson M. Patient and Tumour Characteristics of Keratoacanthoma in a Large, Community-based Cohort Study from Queensland, Australia. Acta Dermato-Venereologica. 2021;101(6):adv00469–adv00469.
Available from: https://medicaljournalssweden.se/actadv/article/view/644.
