Stucco Keratosis

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Background

Stucco keratosis was first described by Kocsard and Ofner in 1965 and later by Willoughby and Soter in 1972.[1, 2]

Stucco keratosis is a keratotic papule that is usually found on the distal lower acral extremities of males. Stucco keratosis seems to appear with a higher frequency in males; however, it is not inherited genetically.

Usually, multiple lesions are found in stucco keratosis; in one study, between 7 and more than 100 lesions were noted on the patients. The lesion is asymptomatic, and patients usually do not complain of having the lesions. The name stucco keratosis is derived from the "stuck on" appearance of the lesions.

Pathophysiology

Stucco keratosis appears to be produced by thickening of the epidermis. The epidermis is usually exophytic with a church spire–like appearance. The surface may be regularly distributed into folds with elongation of papillae. The stratum corneum is thickened.

Surface friction may contribute to the development of stucco keratosis lesions. The tumor grows outward and does not penetrate. The lesions are usually found in elderly patients.

With a nested polymerase chain reaction technique, human papillomavirus types 9, 16, 23b, DL322, and 37 were detected in a 75-year-old nonimmunosuppressed man with very extensive stucco keratosis lesions.[3] This finding requires confirmation in other patients.

Epidemiology

Frequency

United States

The incidence of stucco keratosis is approximately 10% of the senior population in the United States. Stucco keratosis predominantly occurs in elderly men.

Mortality/Morbidity

Race

Sex

Age

History

Physical

Causes

Laboratory Studies

No laboratory studies are required in stucco keratosis.

Imaging Studies

No imaging studies are required in stucco keratosis.

Procedures

Different methods or a combination of methods can be used to remove the stucco keratosis lesions. The most common methods in practice are liquid nitrogen therapy and curettage.

Histologic Findings

A church spire–like epidermal hyperplasia similar to that in hyperkeratotic seborrheic keratosis is seen, as in the image below.


View Image

Photomicrograph of characteristic church spires of stucco keratosis.

Medical Care

Stucco keratosis is a benign lesion that can be removed by curettage or cryotherapy. No other medical care is required.

Surgical Care

No surgical care is required in stucco keratosis.

Medication Summary

No medical therapy is required in stucco keratosis.

Further Outpatient Care

Patients with stucco keratosis should be advised to have a periodic skin examination.

Author

Raymond T Kuwahara, MD, MBA, Dermatologist

Disclosure: Nothing to disclose.

Coauthor(s)

Ron Rasberry, MD, Associate Professor, Department of Dermatology, University of Tennessee Health Science Center College of Medicine; Chief of Dermatology, Veterans Affairs Medical Center at Memphis

Disclosure: Nothing to disclose.

Specialty Editors

Evan R Farmer, MD, Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Disclosure: Nothing to disclose.

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Disclosure: Nothing to disclose.

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York

Disclosure: Nothing to disclose.

References

  1. Kocsard E, Carter JJ. The papillomatous keratoses. The nature and differential diagnosis of stucco keratosis. Australas J Dermatol. Aug 1971;12(2):80-8. [View Abstract]
  2. Willoughby C, Soter NA. Stucco keratosis. Arch Dermatol. Jun 1972;105(6):859-61. [View Abstract]
  3. Stockfleth E, Rowert J, Arndt R, Christophers E, Meyer T. Detection of human papillomavirus and response to topical 5% imiquimod in a case of stucco keratosis. Br J Dermatol. Oct 2000;143(4):846-50. [View Abstract]
  4. Waisman M. Verruciform manifestations of keratosis follicularis: including a reappraisal of hard nevi (Unna). Arch Dermatol. 1960;81:1-15.
  5. Hafner C, Landthaler M, Mentzel T, Vogt T. FGFR3 and PIK3CA mutations in stucco keratosis and dermatosis papulosa nigra. Br J Dermatol. Mar 2010;162(3):508-12. [View Abstract]
  6. Kirkham N. Tumors and cysts of the epidermis. In: Lever's Histopathology of the Skin. Philadelphia, Pa: WB Saunders; 1997:693.

Stucco keratosis in a 70-year-old male veteran. A few scattered white plaques are on the lower extremity.

Photomicrograph of characteristic church spires of stucco keratosis.

Stucco keratosis in a 70-year-old male veteran. A few scattered white plaques are on the lower extremity.

Photomicrograph of characteristic church spires of stucco keratosis.