Stucco Keratosis
Last Updated: September 4, 2003 Rate this Article
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Synonyms and related keywords: verruca dorsimanus et pedis
AUTHOR INFORMATION Section 1 of 11
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Author: Raymond T Kuwahara, MD, Dermatologist, Private Practice
Coauthor(s): Ron Rasberry, MD, Chief of Dermatology, Veterans Medical Center at Memphis; Associate Professor, Department of Dermatology, University of Tennessee at Memphis
Raymond T Kuwahara, MD, is a member of the following medical societies: American Academy of Dermatology
Editor(s): Evan R Farmer, MD, Professor of Dermatology, Johns Hopkins University School of Medicine, Clinical Professor of Pathology, Virginia Commonwealth University School of Medicine; Consulting Staff, Department of Dermatology, Johns Hopkins Hospital, VCU Health Services; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey; 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; and Dirk M Elston, MD, Teaching Faculty, Department of Dermatology, Geisinger Medical Center
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INTRODUCTION Section 2 of 11
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Background: Stucco keratosis was first described by Kocsard and Ofner in 1965 and later by Willoughby and Soter in 1972.
Stucco keratosis is a keratotic papule that is usually found on the distal lower acral extremities of males. It seems to appear with a higher frequency in males; however, it is not inherited genetically.
Usually, multiple lesions are found; 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 the lesions. The tumor grows outward and does not penetrate. The lesions are usually found in elderly patients.
Frequency:
In the US: The incidence of stucco keratosis is about 10% of the senior population in the United States. It predominantly occurs in elderly men.
Mortality/Morbidity:
The lesions are benign growths similar to those of seborrheic keratosis.
Clinically, they may be mistaken as a melanoma.
Race:
Stucco keratosis is found in all races.
No reports have been noted on race as a factor in this lesion.
Sex: The incidence is higher in males than in females.
Age:
Elderly people are susceptible to the disease.
The lesions begin to appear around age 45 years.
CLINICAL Section 3 of 11
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History:
Stucco keratosis is a benign lesion usually mistaken as seborrheic keratosis.
These lesions are often seen in elderly men.
The lesions are asymptomatic and usually go unnoticed by both the patient and the clinician.
Physical:
The lesion appears as a keratotic papule or plaque on the lower extremities but is sometimes found on the upper extremities, usually acrally (see Image 1).
If the lesion is removed by curetting, a peripheral collarette of scale is sometimes left.
No bleeding is noted as in psoriasis.
Causes:
No known cause has been reported.
The epidermis is hyperplastic and usually exophytic with no dysplasia. This is similar to what is seen in seborrheic keratosis.
DIFFERENTIALS Section 4 of 11
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Acrokeratosis Verruciformis of Hopf
Other Problems to be Considered:
Hard nevus of Unna has a similar histopathologic feature of a saw tooth epidermis. The term hard nevus is not used anymore in the literature but could be a term that includes what is described as stucco keratosis.
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WORKUP Section 5 of 11
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Lab Studies:
No laboratory studies are required.
Imaging Studies:
No imaging studies are required.
Procedures:
Different methods or a combination of methods can be used to remove the lesions. The most common methods in practice are liquid nitrogen therapy and curettage.
Liquid nitrogen therapy
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 15 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.
Curettage
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 that can be used include the following:
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: Basaloid cells and horn cysts are not seen, as in seborrheic keratosis. A church spire–like epidermal hyperplasia similar to that in seborrheic keratosis is seen (see Image 2).
TREATMENT Section 6 of 11
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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.
MEDICATION Section 7 of 11
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No medical therapy is required.
FOLLOW-UP Section 8 of 11
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Further Outpatient Care:
Patients should be advised to have a periodic skin examination.
Patient Education:
Patients 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.
MISCELLANEOUS Section 9 of 11
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Medical/Legal Pitfalls:
A biopsy should be performed on lesions that do not scrape off easily or have unusual colors if the clinical diagnosis is not clear.
Squamous cell carcinomas and possibly melanomas can look like stucco keratosis.
PICTURES Section 10 of 11
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Caption: Picture 1. Stucco keratosis in a 70-year-old male veteran. A few scattered white plaques are on the lower extremity.
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Caption: Picture 2. Photomicrograph of characteristic church spires of stucco keratosis.
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BIBLIOGRAPHY Section 11 of 11
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Kirkham N: Tumors and cysts of the epidermis. In: Lever's Histopathology of the Skin. 1997:693.
Kocsard E, Carter JJ: The papillomatous keratoses. The nature and differential diagnosis of stucco keratosis. Australas J Dermatol 1971 Aug; 12(2): 80-8[Medline].
Wasiman M: Verruciform manifestations of keratosis follicularis: including a reappraisal of hard nevi (Unna). Arch Dermatol 1960; 81: 1-15.
Willoughby C, Soter NA: Stucco keratosis. Arch Dermatol 1972 Jun; 105(6): 859-61[Medline].
NOTE:
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER
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