{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:48:11Z","timestamp":1787615291322,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,8,8]],"date-time":"2006-08-08T00:00:00Z","timestamp":1154995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2007,1]]},"abstract":"A 27\u2010year\u2010old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9\u00a0years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16\u00a0years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9\u2010year\u2010old daughter. Her child had no skin lesions. The patient's only medication was Ortho\u2010Tricyclene birth control pills. She had no known drug allergies.<\/jats:p>Physical examination revealed the presence of multiple lesions on her body (Fig.\u00a01<\/jats:ext-link>). Her left superior helix contained a well\u2010demarcated, dome\u2010shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5\u00a0mm to 3\u00a0cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal.<\/jats:p>Initial presentation of left ear and anterior legs before treatment<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo\u2010\/endophytic growth having a central crater containing keratinous material (Fig.\u00a02<\/jats:ext-link>). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas.<\/jats:p>Keratoacanthoma exhibiting an exo\u2010 and endophytic growth pattern with a central crater containing keratin (hematoxylin and eosin; original magnification, \u00d740)<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537\u00a0mg\/dL (normal, <\u00a0150\u00a0mg\/dL) and 225\u00a0mg\/dL (normal, <\u00a0200\u00a0mg\/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple keratoacanthomas, she was referred to her primary care physician for control of hyperlipidemia. After her lipids had been controlled, she was placed on isotretinoin (Accutane) 40\u00a0mg\/day. There was some interval improvement with regression of some lesions leaving atrophic scars. She was also started on topical application of tazarotene (Tazorac) for all nonresolving lesions. Possible side\u2010effects from the isotretinoin occurred, including dry mouth and eyes. After 8\u00a0months of isotretinoin, the patient was switched to acitretin (Soriatane) 25\u00a0mg to determine whether it might have a more beneficial effect on the resistant lesions. Many of the larger lesions regressed leaving atrophic scars. The dose of acitretin was subsequently increased to 35\u00a0mg because the lesions on her heel and the ball of her foot persisted. Almost all of the lesions resolved, except those on her feet, which are slowly regressing. Currently, the patient is on a regimen of acitretin 25\u00a0mg once a day with tazarotene 0.1% gel applied directly to the few residual keratoacanthomas on her feet, which are slowly improving.<\/jats:p>","DOI":"10.1111\/j.1365-4632.2006.02948.x","type":"journal-article","created":{"date-parts":[[2006,8,8]],"date-time":"2006-08-08T18:50:23Z","timestamp":1155063023000},"page":"77-79","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas"],"prefix":"10.1111","volume":"46","author":[{"given":"Ron J.","family":"Feldman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Maize","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,1,3]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/ng0293-165"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004390050635"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2004.30080.x"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(94)70001-X"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(93)70180-2"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1980.tb00365.x"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(90)70305-2"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.139.10.1363-g"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0560.2003.00092.x"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.2002.04925.x"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2003.11.065"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1159\/000018157"},{"key":"e_1_2_3_14_2","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1001\/archderm.1973.01620260067028","article-title":"Letters to the editor: keratoacanthoma treated with methotrexate","volume":"108","author":"Kestel JL","year":"1973","journal-title":"Arch Dermatol"},{"key":"e_1_2_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(91)70301-H"},{"key":"e_1_2_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(82)80019-4"},{"key":"e_1_2_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(93)70174-R"},{"key":"e_1_2_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2004.01025.x"},{"key":"e_1_2_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(84)80331-X"},{"key":"e_1_2_3_20_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.2000.03430.x"},{"key":"e_1_2_3_21_2","doi-asserted-by":"publisher","DOI":"10.1159\/000248665"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-4632.2006.02948.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-4632.2006.02948.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T21:14:49Z","timestamp":1696886089000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4632.2006.02948.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,1]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2007,1]]}},"alternative-id":["10.1111\/j.1365-4632.2006.02948.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-4632.2006.02948.x","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,1]]},"assertion":[{"value":"2007-01-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}