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Keratoacanthoma Medication

  • Author: Tsu-Yi Chuang, MD, MPH, FAAD; Chief Editor: William D James, MD  more...
 
Updated: Feb 29, 2016
 

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.

Antineoplastic agents (eg, topical and intralesional 5-fluorouracil, intralesional methotrexate, interferon alfa-2a,[31] and bleomycin) have been used with some success in treating keratoacanthomas.

Retinoidlike agents are efficacious in the treatment of keratoacanthomas with good cosmetic outcome.[32]

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Antineoplastics

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, 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 weeks the lesion has not responded fully to medical therapy, surgical removal is indicated.

Methotrexate (Trexall, Rheumatrex)

 

Methotrexate is an antimetabolite that inhibits DNA synthesis and cell reproduction in malignant cells. It may suppress the immune system. Satisfactory response may be seen within 3-6 weeks following administration. A marked response may be noticed after 2 injections (1 study).

Fluorouracil (Adrucil)

 

Fluorouracil is a fluorinated pyrimidine antimetabolite that inhibits thymidylate synthase (TS) and interferes with RNA synthesis and function. It has some effect on DNA. It is useful in symptom palliation for patients with progressive disease.

Bleomycin

 

Bleomycin is a glycopeptide antibiotic that inhibits DNA synthesis. The concentration usually is 1 mg/mL and diluted further with local anesthetic.

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Retinoid-like Agents

Class Summary

These agents are efficacious in the treatment of keratoacanthomas with good cosmetic outcome. They decrease sebaceous gland size and sebum production and may inhibit sebaceous gland differentiation and abnormal keratinization.

Isotretinoin (Amnesteem, Claravis, Sotret)

 

Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a synthetic 13-cis isomer of naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A. Acitretin is another retinoid. However, oral retinoids are more often used in patients with multiple keratoacanthomas.

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

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Topical Skin Products

Class Summary

The agent imiquimod has been reported to show some efficacy. However, the mechanism of action of imiquimod cream in treating keratosis is unknown.

Imiquimod (Aldara, Zyclara)

 

Imiquimod is an immune response modifier currently approved for the treatment of genital and perianal warts. It is capable of inducing IFN-alpha, TNF-alpha, IL-1, IL-6, and IL-8. Studies using 5% cream in mice showed significant induction of IFN-alpha at the application site occurring as early as 2 hours after treatment. At 4 hours after application, increases in IFN-alpha mRNA levels were found, indicating an increase in transcription. It is not approved by the FDA for use in hypertrophic scars and keloids.

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Contributor Information and Disclosures
Author

Tsu-Yi Chuang, MD, MPH, FAAD Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Dermatologist, HealthCare Partners

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, American Medical Association

Disclosure: Nothing to disclose.

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

References
  1. Manstein CH, Frauenhoffer CJ, Besden JE. Keratoacanthoma: is it a real entity?. Ann Plast Surg. 1998 May. 40(5):469-72. [Medline].

  2. Gleich T, Chiticariu E, Huber M, Hohl D. Keratoacanthoma: A distinct entity?. Exp Dermatol. 2015 Oct 17. [Medline].

  3. Ra SH, Su A, Li X, Zhou J, Cochran AJ, Kulkarni RP, et al. Keratoacanthoma and squamous cell carcinoma are distinct from a molecular perspective. Mod Pathol. 2015 Jun. 28(6):799-806. [Medline].

  4. Kanzaki A, Kudo M, Ansai S, Peng WX, Ishino K, Yamamoto T, et al. Insulin-like growth factor 2 mRNA-binding protein-3 as a marker for distinguishing between cutaneous squamous cell carcinoma and keratoacanthoma. International journal of oncology. 2016 Mar. 48(3):1007-15. [Medline].

  5. Schwartz RA. Keratoacanthoma. J Am Acad Dermatol. 1994 Jan. 30(1):1-19; quiz 20-2. [Medline].

  6. Magalhaes RF, Cruvinel GT, Cintra GF, Cintra ML, Ismael AP, de Moraes AM. Diagnosis and follow-up of keratoacanthoma-like lesions: clinical-histologic study of 43 cases. J Cutan Med Surg. 2008 Jul-Aug. 12(4):163-73. [Medline].

  7. Kossard S, Tan KB, Choy C. Keratoacanthoma and infundibulocystic squamous cell carcinoma. Am J Dermatopathol. 2008 Apr. 30(2):127-34. [Medline].

  8. Cribier B, Asch P, Grosshans E. Differentiating squamous cell carcinoma from keratoacanthoma using histopathological criteria. Is it possible? A study of 296 cases. Dermatology. 1999. 199(3):208-12. [Medline].

  9. Macdonald JB, Macdonald B, Golitz LE, LoRusso P, Sekulic A. Cutaneous adverse effects of targeted therapies: Part II: Inhibitors of intracellular molecular signaling pathways. J Am Acad Dermatol. 2015 Feb. 72 (2):221-36; quiz 237-8. [Medline].

  10. Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Kauai, Hawaii. The first documented incidence in a defined population. Arch Dermatol. 1993 Mar. 129(3):317-9. [Medline].

  11. Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Squamous cell carcinoma in Kauai, Hawaii. Int J Dermatol. 1995 Jun. 34(6):393-7. [Medline].

  12. Chuang TY, Reizner GT, Elpern DJ, Stone JL, Farmer ER. Non-melanoma skin cancer and keratoacanthoma in Filipinos: an incidence report from Kauai, Hawaii. Int J Dermatol. 1993 Oct. 32(10):717-8. [Medline].

  13. Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Keratoacanthoma in Japanese Hawaiians in Kauai, Hawaii. Int J Dermatol. 1995 Dec. 34(12):851-3. [Medline].

  14. Reizner GT, Chuang TY, Elpern DJ, Stone JL, Farmer ER. Basal cell carcinoma and keratoacanthoma in Hawaiians: an incidence report. J Am Acad Dermatol. 1993 Nov. 29(5 Pt 1):780-2. [Medline].

  15. Letzel S, Drexler H. Occupationally related tumors in tar refinery workers. J Am Acad Dermatol. 1998 Nov. 39(5 Pt 1):712-20. [Medline].

  16. Miot HA, Miot LD, da Costa AL, Matsuo CY, Stolf HO, Marques ME. Association between solitary keratoacanthoma and cigarette smoking: a case-control study. Dermatol Online J. 2006 Feb 28. 12(2):2. [Medline].

  17. Hsi ED, Svoboda-Newman SM, Stern RA, Nickoloff BJ, Frank TS. Detection of human papillomavirus DNA in keratoacanthomas by polymerase chain reaction. Am J Dermatopathol. 1997 Feb. 19(1):10-5. [Medline].

  18. Lu S, Syrjanen SL, Havu VK, Syrjanen S. Known HPV types have no association with keratoacanthomas. Arch Dermatol Res. 1996 Mar. 288(3):129-32. [Medline].

  19. Wieland U, Scola N, Stolte B, Stucker M, Silling S, Kreuter A. No evidence for a causal role of Merkel cell polyomavirus in keratoacanthoma. J Am Acad Dermatol. 2012 Jul. 67(1):41-6. [Medline].

  20. Alloo A, Garibyan L, LeBoeuf N, et al. Photodynamic therapy for multiple eruptive keratoacanthomas associated with vemurafenib treatment for metastatic melanoma. Arch Dermatol. 2012 Mar. 148(3):363-6. [Medline].

  21. Clausen OP, Beigi M, Bolund L, et al. Keratoacanthomas frequently show chromosomal aberrations as assessed by comparative genomic hybridization. J Invest Dermatol. 2002 Dec. 119(6):1367-72. [Medline].

  22. Kim DK, Kim JY, Kim HT, Han KH, Shon DG. A specific chromosome aberration in a keratoacanthoma. Cancer Genet Cytogenet. 2003 Apr 1. 142(1):70-2. [Medline].

  23. Cabibi D, Conway de Macario E, Ingrao S, Porcasi R, Zucco F, Macario AJ, et al. CD1A-positive cells and HSP60 (HSPD1) levels in keratoacanthoma and squamous cell carcinoma. Cell Stress Chaperones. 2015 Oct 6. [Medline].

  24. Hatta N, Takata A, Ishizawa S, Niida Y. Family with MSH2 mutation presenting with keratoacanthoma and precancerous skin lesions. J Dermatol. 2015 Nov. 42 (11):1087-90. [Medline].

  25. Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. 1998 Jul. 62(1):37-9. [Medline].

  26. Patel NP, Cervino AL. Treatment of keratoacanthoma: Is intralesional methotrexate an option?. Can J Plastic Surg. Summer 2011. (19)2:e15-8.

  27. Sanders S, Busam KJ, Halpern AC, Nehal KS. Intralesional corticosteroid treatment of multiple eruptive keratoacanthomas: case report and review of a controversial therapy. Dermatol Surg. 2002 Oct. 28(10):954-8. [Medline].

  28. Sayama S, Tagami H. Treatment of keratoacanthoma with intralesional bleomycin. Br J Dermatol. 1983 Oct. 109(4):449-52. [Medline].

  29. Annest NM, VanBeek MJ, Arpey CJ, Whitaker DC. Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature. J Am Acad Dermatol. 2007 Jun. 56(6):989-93. [Medline].

  30. Dendorfer M, Oppel T, Wollenberg A, Prinz JC. Topical treatment with imiquimod may induce regression of facial keratoacanthoma. Eur J Dermatol. 2003 Jan-Feb. 13(1):80-2. [Medline].

  31. Grob JJ, Suzini F, Richard MA, et al. Large keratoacanthomas treated with intralesional interferon alfa-2a. J Am Acad Dermatol. 1993 Aug. 29(2 Pt 1):237-41. [Medline].

  32. Canas GC, Robson KJ, Arpey CJ. Persistent keratoacanthoma: challenges in management. Dermatol Surg. 1998 Dec. 24(12):1364-9. [Medline].

  33. Frank TL, Maguire HC Jr, Greenbaum SS. Multiple painful keratoacanthomas. Int J Dermatol. 1996 Sep. 35(9):648-50. [Medline].

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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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