Grzybowski Type Generalized Eruptive Keratoacanthomas Covering 95% of the Body Surface and Bilateral Ectropion - Part 1: When Donor Site Options Become Scarce

Abstract

Introduction: We treated a patient suffering from generalized eruptive keratoacanthomas, also known as Grzybowski syndrome. Since its first description in 1950, around 40 cases were reported worldwide. Materials and Methods: A 66-year old woman with bilateral eyelid cicatricial ectropions was referred to our plastic surgery department. This patient was previously diagnosed with generalized eruptive keratoacanthomas of Grzybowski type. Her periocular skin was thickened with a cobblestone appearance. Cicatricial ectropions involved both upper and lower eyelids on the left side and the lower eyelid on the right side. The most affected left side was treated first using a full-thickness skin graft harvested from the dorsum of the left foot, as 95 % of the body surface of the patient were covered by keratoacanthomas. Results: Stable results with reduced tearing and improved appearence were achieved after 6 weeks with delayed healing of the donor site after three months. Conclusion: A full-thickness skin graft is the best option to treat cicatricial ectropion, but in case of patients with Grzybowski’s syndrome, donor site options are scarce and wound healing difficulties may become a problem. Thinking out of the box for treatment of the second side and eventual further operations is key.