Generalized eruptive keratoacanthoma of Grzybowski: strict diagnostic criteria are still lacking

Abstract

Conflict of interest: none declared. We read with interest the article by Davies and Davies on multiple eruptive keratoacanthoma (KA) entitled ‘A widespread, itchy papular eruption’,1 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,2,3,4,5 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).