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Therapeutics in Dermatology
A reference textbook in dermatology

Stucco keratosis

3 March 2017, by KANITAKIS J. & CRIBIER B.

Stucco keratoses (SK) are benign skin lesions affecting adults, especially men. They are small, raised, whitish or greyish lumps with a dry, rough surface that look as though they have been "stuck on" to the skin (hence their name). They measure from 1 to 4 mm in diameter and are found on the upper surface of the feet, the ankles and legs, and more rarely on the forearms and thighs; they tend to be more obvious in winter, when the skin is drier. They are diagnosed by dermatological examination; sometimes small samples of the skin may be removed and examined under the microscope. We do not know what causes SKs, although it appears likely that the sun plays a role given their location on exposed areas of skin. The virus that causes warts (HPV) was found in the SKs of one patient but the role played by the virus in the development of SKs is unclear.

There is no real need to treat the lesions as they are totally harmless and can even be self-limiting; however, some patients may request treatment on cosmetic grounds. There is no definitive cure, the aim of the various treatment options available being to destroy the existing lesions. They can be scraped off with a curette (a metal tool with a sharp edge) without bleeding; they can also be removed with a fingernail. They can be frozen off with liquid nitrogen or burned off with an electric scalpel. Some topical preparations (containing urea or salicylic or lactic acid) help improve the lesions. Other topical preparations containing a product generally used to treat genital warts (imiquimod) and a vitamin D derivative (maxacalcitol) may also be useful. Capsules containing a vitamin A derivative (etretinate) can also be taken but their effects are temporary.

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