Generalized eruptive keratoacanthoma of the Grzybowski type: some considerations on treatment and pathogenesis

A 64‐year‐old male patient presented with a 2‐month history of a generalized mucocutaneous eruption characterized by suspected keratoacanthomas (KAs), umbilicated papules, and small follicular papules, which mainly involved the face, upper limbs, and trunk; the oral mucosa was affected as well. The presence of HPV‐16 DNA harbored in GEKA lesions does not allow any conclusive consideration on the etiological role of HPV infection and the role of HPV in keratoacanthomas remains thus elusive. However, its potential involvement in the pathogenesis of this disorder supports the retinoids as the first therapeutic option. Retinoids could be effective in GEKA treatment not only because of their antitumor properties but also by altering keratinization and inhibiting HPV replication and assembly. In keeping with this, an inverse relation has been observed between concentration of retinoids and HPV DNA within infected epithelial cells.15 We recommend the evaluation of the role of HPV infection in GEKA as meritorious of further investigation.