Stucco Keratosis



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.


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.



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


Stucco keratosis is found in persons of all races. No reports have been noted on race as a factor in stucco keratosis.


The incidence of stucco keratosis is higher in males than in females.


Elderly people are susceptible to stucco keratosis. The stucco keratosis lesions begin to appear around age 45 years.


The lesions of stucco keratosis are benign growths similar to those of seborrheic keratosis. Clinically, stucco keratosis lesions may be mistaken as a melanoma.

Patient Education

Patients with stucco keratosis can be informed that the lesions are not cancerous. Because lesions are found in elderly patients, the patients can be taught the "ABCDs" of melanoma.


Stucco keratosis is a benign lesion that is best regarded as a form of seborrheic keratosis. Stucco keratosis lesions are often seen in elderly men. The stucco keratosis lesions are asymptomatic and usually go unnoticed by both the patient and the clinician.


Stucco keratosis lesions appear as keratotic papules or plaques on the lower extremities but are sometimes found on the upper extremities, usually acrally. Note the image below. If the lesion is removed by curetting, a peripheral collarette of scale is sometimes left.

View Image

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


No known cause of stucco keratosis has been reported. The epidermis is hyperplastic and usually exophytic with no dysplasia. This is similar to what is seen in seborrheic keratosis.

Laboratory Studies

No laboratory studies are required in stucco keratosis.

Imaging Studies

No imaging studies are required in stucco keratosis.


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.

Liquid nitrogen therapy in stucco keratosis

Lesions can be frozen with liquid nitrogen by either the spray method or the dipstick method. Because the lesions are benign, the required temperature of the lesion should reach -25°C.

Depending on the thickness of the lesion, 2 freeze cycles of 3-10 seconds are usually required. The lesions fall off in a few days, and, if the procedure is not successful, liquid nitrogen therapy may be repeated. Ambient temperature and skin temperature as well as underlying vascularity must be taken into account. Ulceration can occur if cryotherapy is too vigorous.

Curettage in stucco keratosis

Stucco keratosis can be removed by curettage. Lesions can be removed by gentle scraping. Once the lesion is removed, a topical antibiotic can be applied.

Other methods used in stucco keratosis

The lesion can be removed by using an electrodesiccator.

Shave removal is performed only if the lesion appears malignant, does not scrape off, or requires a definitive diagnosis.

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. See Procedures for details.

Surgical Care

No surgical care is required in stucco keratosis.

Long-Term Monitoring

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

Medication Summary

No medical therapy is required in stucco keratosis.


Raymond T Kuwahara, MD, MBA, Dermatologist

Disclosure: Nothing to disclose.

Specialty Editors

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, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.


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

Ron Rasberry, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Arkansas Medical Society, Association of Military Surgeons of the US, Royal Society of Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.


  1. Kocsard E, Carter JJ. The papillomatous keratoses. The nature and differential diagnosis of stucco keratosis. Australas J Dermatol. 1971 Aug. 12(2):80-8. [View Abstract]
  2. Willoughby C, Soter NA. Stucco keratosis. Arch Dermatol. 1972 Jun. 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. 2000 Oct. 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. Errichetti E, Stinco G. Dermoscopy in General Dermatology: A Practical Overview. Dermatol Ther (Heidelb). 2016 Sep 9. [View Abstract]
  6. Sezer E, Özturk Durmaz E, Çetin E, Şahin S. Meyerson Phenomenon as a Component of Melanoma in situ. Acta Dermatovenerol Croat. 2016 Apr. 24 (1):81-2. [View Abstract]
  7. Hafner C, Landthaler M, Mentzel T, Vogt T. FGFR3 and PIK3CA mutations in stucco keratosis and dermatosis papulosa nigra. Br J Dermatol. 2010 Mar. 162(3):508-12. [View Abstract]
  8. Kirkham N. Tumors and cysts of the epidermis. 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.