Stucco keratosis
Keratosis alba; "barnacles of ageing" (of the feet)
Stucco keratosis is a common, entirely benign keratotic variant of seborrhoeic keratosis that affects the dorsal feet, ankles and lower legs of older adults. Lesions are characteristically small (1–4 mm), white-grey, dry, scaly papules that can be lifted off without bleeding — the eponym refers to their plaster-of-Paris (stucco) appearance. Diagnosis is clinical; histology confirms an exophytic compact hyperkeratotic seborrhoeic keratosis variant. Treatment is rarely required and is cosmetic only — emollients and gentle keratolytics suffice.
Clinical features
- Multiple discrete, dry, white-grey papules 1–4 mm; flat-topped or slightly raised.
- Distribution — dorsal feet, ankles, lower legs, less commonly forearms.
- Lesions are loosely attached and can be lifted off with a fingernail without bleeding — the most reliable diagnostic clue.
- Onset typically > 50 years; male predominance; chronic sun-damaged, dry skin.
- Asymptomatic.
Histology
- Exophytic compact orthokeratotic hyperkeratosis with mild acanthosis.
- Church-spire pattern of upward keratinocyte papillation.
- Minimal or absent inflammatory infiltrate.
- Histologically distinct from acrokeratosis verruciformis of Hopf (autosomal dominant, hands > feet).
Differential
- Verruca vulgaris — typically thicker, with punctate haemorrhages, often single or grouped on weight-bearing surfaces.
- Acrokeratosis verruciformis of Hopf — familial, dorsal hands, autosomal dominant.
- Hyperkeratotic seborrhoeic keratoses on lower legs — overlap entity.
- Lichen planus / actinic keratosis on the dorsum of the feet — biopsy if uncertain.
- Stasis dermatitis / xerosis — diffuse, not discrete papules.
Management
- Reassurance — no treatment required.
- Emollients (urea 10–20% cream) for symptomatic xerosis.
- Cosmetic options — curettage, mild cryotherapy, salicylic acid 5–10%.
- Biopsy only if any single lesion looks atypical.
References
- Kocsard E, Ofner F. Keratoses palmoplantaris alba — stucco keratosis. Aust J Dermatol; 1965 (original description).
- Braun-Falco O. Dermatology. 4th edition. Springer; chapter on seborrhoeic keratosis variants.
Spot a correction?
If any clinical statement, citation or link on this page needs updating, please email admin@skinoncology.net with the page name, the proposed correction and the supporting source.