{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:30:03Z","timestamp":1768815003183,"version":"3.49.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Sorafenib is an oral multikinase inhibitor that targets Raf serine\/threonine  receptor tyrosine kinases and inhibits tumor cell growth and angiogenesis. Cutaneous toxicities of sorafenib are common, including cutaneous eruptions (such as truncal erythema and seborrheic-dermatitis-like changes) and hand\u2013foot syndrome. Keratoacanthomas and squamous cell carcinomas have been reported previously; however, we report a case of multiple eruptive keratoacanthomas in the form of Grzybowski syndrome after initiation of sorafenib.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We report a 63-year-old Caucasian male who developed multiple cutaneous eruptive keratoacanthomas after starting sorafenib 400\u00a0mg twice daily. He had a known history of hepatitis-C-related cirrhosis and hepatocellular carcinoma, and previously had actinic keratosis and skin squamous cell carcinoma excision. Approximately two and a half months after starting sorafenib, the patient initially developed two lesions, one on each forearm, and after excision, these lesions demonstrated histological features of squamous cell carcinoma. One month later, the patient presented with approximately 48 new skin lesions of varying size on the back, bilateral upper limbs, and face requiring excisional biopsy of a large number of these lesions. Histopathology showed eruptive invasive keratoacanthomas (Grzybowski syndrome). Sorafenib was temporarily stopped and subsequently restarted at a lower dose. Acitretin 25\u00a0mg daily was commenced after few weeks, and no further keratoacanthomas developed during his treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We report a unique case of sorafenib-associated Grzybowski syndrome. Temporary interruption and dose reduction of sorafenib and use of acitretin appeared to prevent further development of keratoacanthomas.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-03037-4","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T23:04:48Z","timestamp":1632179088000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Sorafenib-related generalized eruptive keratoacanthomas (Grzybowski syndrome): a\u00a0case report"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-3708","authenticated-orcid":false,"given":"M. Nazim","family":"Abbas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei Son","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganessan","family":"Kichenadasse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,21]]},"reference":[{"issue":"2","key":"3037_CR1","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1517\/14740330903510608","volume":"9","author":"B Blanchet","year":"2010","unstructured":"Blanchet B, Billemont B, Barete S, Garrigue H, Cabanes L, Coriat R, et\u00a0al. Toxicity of sorafenib: clinical and molecular aspects. Expert Opin Drug Saf. 2010;9(2):275\u201387.","journal-title":"Expert Opin Drug Saf"},{"issue":"1","key":"3037_CR2","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.jaad.2006.10.032","volume":"56","author":"HH Kong","year":"2007","unstructured":"Kong HH, Cowen EW, Azad NS, Dahut W, Gutierrez M, Turner ML. Keratoacanthomas associated with sorafenib therapy. J Am Acad Dermatol. 2007;56(1):171\u20132.","journal-title":"J Am Acad Dermatol"},{"issue":"23","key":"3037_CR3","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1200\/JCO.2009.23.4823","volume":"27","author":"JP Arnault","year":"2009","unstructured":"Arnault JP, Wechsler J, Escudier B, Spatz A, Tomasic G, Sibaud V, et\u00a0al. Keratoacanthomas and squamous cell carcinomas in patients receiving sorafenib. 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Sydney: Cancer Council Australia; 2008 https:\/\/wiki.cancer.org.au\/australia\/File:Final_2008_Guidelines_Basal_cell_carcinoma_Squamous_cell_carcinoma.pdf."},{"issue":"4","key":"3037_CR6","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1159\/000066422","volume":"205","author":"RA Schwartz","year":"2002","unstructured":"Schwartz RA, Blaszczyk M, Jablonska S. Generalized eruptive keratoacanthoma of Grzybowski: follow-up of the original description and 50-year retrospect. Dermatology. 2002;205(4):348\u201352.","journal-title":"Dermatology"},{"issue":"2","key":"3037_CR7","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/ijd.12318","volume":"53","author":"CL Anzalone","year":"2014","unstructured":"Anzalone CL, Cohen PR. Generalized eruptive keratoacanthomas of Grzybowski. Int J Dermatol. 2014;53(2):131\u20136.","journal-title":"Int J Dermatol"},{"issue":"4","key":"3037_CR8","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1111\/j.1365-4632.2010.04822.x","volume":"50","author":"VL Williams","year":"2011","unstructured":"Williams VL, Cohen PR, Stewart DJ. Sorafenib-induced premalignant and malignant skin lesions. Int J Dermatol. 2011;50(4):396\u2013402.","journal-title":"Int J Dermatol"},{"issue":"12","key":"3037_CR9","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1016\/j.annder.2009.09.010","volume":"136","author":"H Jantzem","year":"2009","unstructured":"Jantzem H, Dupre-Goetghebeur D, Spindler P, Merrer J. Sorafenib-induced multiple eruptive keratoacanthomas. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"481"}}