Cicatricial Ectropion in Grzybowski Type of Multiple Eruptive Keratoacanthomas

Approach to treatment of cicatricial ectropion: a systematic review and meta-analysis comparing surgical and minimally invasive options

Cicatricial ectropion can involve the skin, subcutaneous tissue, muscle, and septum to result in chronic tearing and keratopathy. Surgery involving the orbital rim or eyelid is a common cause. Minimally invasive techniques may provide alternative options for correction, but the comparative benefit to surgery is unknown. To compare the efficacy of surgical and minimally invasive minimally invasive treatment options for cicatricial ectropion. A comprehensive literature search of Medline, EMBASE, and the Cochrane Library published from 1960 to August 2019 was performed for studies that described any treatment of cicatricial ectropion. 1391 studies were found, of which 31 had extractable data for 299 patients. Pooling of outcome data occurred for the primary and secondary outcomes. The complete and partial response rates to treatment (primary outcomes) as well as the recurrence rate and physician global assessment of cosmesis (secondary outcomes) were analyzed. Surgical correction resulted in complete correction in 79% of patients compared to 63% of hyaluronic acid treated patients. Hyaluronic acid injection had a better aesthetic outcome, but a higher recurrence rate overall. Hyaluronic acid filler with a high G' along with delayed dissolution trended toward a lower recurrence rate. Other minimally invasive treatments had little data. The literature found was limited to mostly single-center, observational studies. Hyaluronic acid may be a viable alternative for cicatricial ectropion in those patients who cannot undergo surgery. Further prospective studies are required to routinely recommend minimally invasive techniques.

[Generalized eruptive keratoacanthomas of Grzybowski: A case report followed over 11 years]

Since 1950, the year of Grzybowski's syndrome description by Marian Grzybowski in Warsaw, 30 cases have been described in the literature. This syndrome belongs to the family of multiple generalized keratoacanthomas (KA). It occurs in adults between 50 and 70 years. Clinically, it presents as a rash of hundreds or thousands of small papules 1 to 2mm with well-defined, sometimes keratotic center. The onset is sudden, the evolution is progressive and chronic. It is accompanied by severe and persistent pruritus. There is no family history of KA and histology is compatible with that of KA. Other criteria may be present to varying degrees: the type of facial rash Mask of Zorro, mucosal rash, ectropion, the presence of crater-like lesions. We studied the case of a 58-year-old patient followed in the plastic surgery department of Nîmes' hospital for excision of several skin tumors as part of a Grzybowski's syndrome evolving since 2005. Its handling global and multidisciplinary treatments combining early surgical and complex medical treatments represents a therapeutic challenge.