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\begin{document}

\title{Successful Treatment of a Keratoacanthoma in a Young Patient with the
Application of Topical 5\% Imiquimod Cream}



\author[1]{Kerasia-Maria Plachouri}%
\author[1]{Francesk Mulita}%
\author[1]{Levan Tchabashvili}%
\author[1]{Elias Liolis}%
\author[1]{Charalampos Kaplanis}%
\author[1]{Ioannis Perdikaris}%
\author[1]{Fotis Iliopoulos}%
\author[1]{Georgios-Ioannis Verras}%
\author[1]{Vasilios Tolias}%
\author[1]{Sophia Georgiou}%
\affil[1]{University General Hospital of Patras Holy Mary the Help}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\selectlanguage{english}
\begin{abstract}
Keratoacanthomas (KA) are epithelial tumors that present as rapidly
evolving nodules with a central hyperkeratotic plug, and occasionally
show signs of spontaneous regression. A 21-years-old patient strongly
refused the diagnostic biopsy and insisted on a non surgical treatment.
He was successfully treated with imiquimod 5\% cream.%
\end{abstract}%



\sloppy


\textbf{CLINICAL IMAGE}

\textbf{Successful Treatment of a Keratoacanthoma in a Young Patient
with the Application of Topical 5\% Imiquimod Cream}

\textbf{Kerasia-Maria Plachouri\textsuperscript{1}, Francesk
Mulita\textsuperscript{2}, Levan Tchabashvili\textsuperscript{2}, Elias
Liolis\textsuperscript{3}, Charalampos Kaplanis\textsuperscript{2},
Ioannis Perdikaris\textsuperscript{2}, Fotios
Iliopoulos\textsuperscript{2}, Georgios-Ioannis
Verras\textsuperscript{2}, Vasilios Tolias\textsuperscript{1}, Sophia
Georgiou\textsuperscript{1}}

\textsuperscript{1}Department of Dermatology, General University
Hospital of Patras, Greece

\textsuperscript{2}Department of General Surgery, General University
Hospital of Patras, Greece

\textsuperscript{3}Department of Internal Medicine, General University
Hospital of Patras, Greece

Correspondence: Francesk Mulita MD, MSc, PhD(c), Resident Surgeon at the
Department of Surgery, General University Hospital of Patras, Achaia,
Greece, Tel.: +30 6982785142; E-mail:\emph{oknarfmulita@hotmail.com};
ORCID Id:\emph{https://orcid.org/0000-0001-7198-2628}

\textbf{Key Clinical Message}

Surgical excision is the most common treatment option for
keratoacanthomas. However, the topical application of the imiquimod 5\%
cream is a safe and effective option, especially for patients who refuse
surgical removal.

\textbf{Case Description}

A 21-year old male presented in our Department due to an asymptomatic
nodule in the proximal fifth digit of the right hand, that had first
appeared 3 months prior to the referral. The lesion rapidly progressed
in size during the first 4 weeks and afterwards remained stable. The
clinical examination revealed a firm skin-coloured nodule, of
approximately 1.8 x 1.8 cm in size, with a central non-removable
keratinous plug (Figure 1A). The clinical diagnosis of keratoacanthoma
was made, and a biopsy was recommended for diagnosis confirmation. The
patient strongly refused the diagnostic biopsy and insisted on a non
surgical treatment. We therefore suggested a regimen of topical
imiquimod 5\% cream under occlusion, for 5 consecutive days per week,
over a period of 4 weeks. 2 weeks after treatment initiation, a
prominent local inflammatory reaction could be documented, resulting in
crust formation and erosion (Figure 1B). 4 weeks after the completion of
treatment, the lesion was markedly flattened, until complete resolution
was achieved (Figure 1C).

Keratoacanthomas (KA) are epithelial tumours that present as rapidly
evolving nodules with a central hyperkeratotic plug, and occasionally
show signs of spontaneous regression {[}1{]}. The treatment of choice
for KAs is surgical excision, as it provides the advantage of complete
tumour removal in a short period of time {[}1-2{]}. However,
conservative therapeutic strategies are also to be considered,
especially when it comes to the management of KAs in visible areas with
a probability of cosmetic disfiguration, or when it comes to treating
patients with multiple KAs {[}2{]}.

\textbf{Keywords:} Keratoacanthomas, imiquimod cream, epithelial tumour

\textbf{Patient consent for publication}

A written informed consent was obtained from the patient for publication
of this case report.

\textbf{Conflict of interest}

There are no conflicts of interest to declare.

\textbf{Financial support and sponsorship}

None

\textbf{Author contribution}

FM, EL, LT, G-IV, IP, FI, CK, VT and K-MP: contributed to the clinical
data collection and prepared the case report. FM, SG and K-MP:
contributed to the design of the case report presentation and performed
the final revision of the manuscript.

\textbf{Data availability}

Data available on request from the authors

\textbf{References}

Pancevski G, Pepic S, Idoska S, Tofoski G, Nikolovska S. Topical
Imiquimod 5\% as a Treatment Option in Solitary Facial Keratoacanthoma.
\emph{Open Access Maced J Med Sci.}2018;\textbf{6} :531-535.

Janik JP, Bang RH. Traumatic Keratoacanthoma Arising in a
15-Year-Old-Boy Following a Motor Vehicle Accident.~\emph{Pediatr
Dermatol.~} 2006;\textbf{23} :448--450.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 1} : A. KA in the proximal fifth digit of the right hand,
before treatment B. KA in the proximal fifth digit of the right hand, 3
weeks after treatment initiation C. Complete resolution of the KA in the
proximal fifth digit of the right hand, 4 weeks after the completion of
treatment\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}

\selectlanguage{english}
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\end{document}

