Keratoacanthoma Medication

  • Author: Tsu-Yi Chuang, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 18, 2011
 

Medication Summary

Although surgical treatment is the modality for keratoacanthoma, in patients with clear-cut and multiple keratoacanthomas, a number of medical alternatives have been used with success.

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Antineoplastic agents

Class Summary

These agents are useful in patients with large or multiple tumors or tumors that are inoperable because of anatomic location or the patient's poor medical status. They also are useful for eruptive keratoacanthomas of the lower legs. Agents (eg, topical and intralesional 5-fluorouracil, intralesional MTX, interferon alfa-2a,[24] and bleomycin) also have been used with some success in treating keratoacanthomas. When small amounts of medication are administered, the interactions and precautions listed below are less restrictive than when systemic doses are administered. As a rule, if after 4 wk the lesion has not responded fully to medical therapy, surgical removal is indicated.

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Methotrexate (Folex, Rheumatrex)

 

Antimetabolite that inhibits DNA synthesis and cell reproduction in malignant cells. May suppress immune system. Satisfactory response seen within 3-6 wk following administration.

Marked response noticed after 2 injections (1 study).

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Fluorouracil (Efudex, Adrucil, Fluoroplex)

 

Fluorinated pyrimidine antimetabolite that inhibits thymidylate synthase (TS) and also interferes with RNA synthesis and function. Has some effect on DNA. Useful in symptom palliation for patients with progressive disease.

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Bleomycin (Blenoxane)

 

Glycopeptide antibiotic that inhibits DNA synthesis.

Concentration usually is 1 mg/mL and diluted further with local anesthetic.

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Retinoids

Class Summary

Efficacious in treatment of keratoacanthomas with good cosmetic outcome.[25] Decrease sebaceous gland size and sebum production. May inhibit sebaceous gland differentiation and abnormal keratinization.

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Isotretinoin (Accutane)

 

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A.

FDA–mandated registry now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information, see iPLEDGE. Registry aims to further decrease risks of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

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Contributor Information and Disclosures
Author

Tsu-Yi Chuang, MD, MPH  Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Staff Dermatologist, Desert Oasis Healthcare

Tsu-Yi Chuang, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Ryan Brashear, MD  Staff Physician, Department of Dermatology, Indiana University School of Medicine

Ryan Brashear, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD  Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Keratoacanthoma (squamous cell carcinoma-keratoacanthoma or SCC-KA type) on inner canthus.
Keratoacanthoma of the left forehead.
Close-up view of the keratoacanthoma.
Keratoacanthoma lesion (squamous cell carcinoma-keratoacanthoma or SCC-KA type).
 
 
 
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