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Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 86-87

Inverted follicular keratosis: A rare lesion revisited

1 Department of Ophthalmology, Dr. Yashwant Singh Parmar Government Medical College, Sirmour, Himachal Pradesh, India
2 Department of Dermatology, Regional Hospital, Hamirpur, Himachal Pradesh, India

Date of Web Publication7-Aug-2017

Correspondence Address:
Anubhav Chauhan
Department of Ophthalmology, Dr. Yashwant Singh Parmar Government Medical College, Nahan, Sirmour - 173 001, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.MJMSR_1_17

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Inverted follicular keratosis is a rare lesion of the follicular infundibulum with characteristic signs and histopathological features. It may mimic malignant lesions, especially squamous cell carcinoma and hence a high degree of suspicion is warranted whenever any patient presents with such growths.

Keywords: Lesions, ocular, skin

How to cite this article:
Chauhan A, Sharma N, Gupta L. Inverted follicular keratosis: A rare lesion revisited. Muller J Med Sci Res 2017;8:86-7

How to cite this URL:
Chauhan A, Sharma N, Gupta L. Inverted follicular keratosis: A rare lesion revisited. Muller J Med Sci Res [serial online] 2017 [cited 2018 Mar 23];8:86-7. Available from: http://www.mjmsr.net/text.asp?2017/8/2/86/212406

  Introduction Top

Inverted follicular keratosis is a rare benign tumor and is thought to be a variant of the seborrheic keratosis.It mostly presents as a solitary nodule with keratotic surface and is seen predominantly seen in middle aged or old patients. Here we report a case of 93 years old female who presented with ocular and dermatological complaints and her skin lesion came out to be inverted follicular keratosis. A high degree of suspicion on the part of the treating ophthalmologist and dermatologist led to the diagnosis.

  Case Report Top

A 93-year-old female [Figure 1] presented to the department of ophthalmology with a history of decreased vision in both the eyes and a mass/growth below both the eyelids for the past 3 years which was progressively increasing in size. There was no other complaint. She was a farmer and average built. There was no significant medical, surgical, personal, family, or drug abuse history. The patient was nonsmoker, nonalcoholic, and vegetarian. Her general physical and systemic examination was within normal limits. Her visual acuity was 6/18 in both the eyes (without any improvement) because of cataract. Rest of the ocular examination was normal. We advised her cataract surgery for the eyes, but she refused. We then referred her to the department of dermatology for the skin lesion.
Figure 1: Patients photo

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The lesions below the lids were present on the cheeks, were nodulo-plaque lesions, 5 × 4 cm in size and the surfaces showed ulceration. The lesion on the right cheek was more prominent than the left one. Routine blood investigations were normal. We planned a surgical excision biopsy of the lesion and the patient was fully informed of the procedure. Only a small piece of the lesion from right cheek was excised for biopsy as the patient did not consent for full removal of the lesion. The specimen was sent for histopathological examination. Histopathology report showed “an endo-exophytic lesion with squamous eddies and areas of basaloid cells arranged haphazardly with mitotic figures plus dense perifollicular inflammation infiltrate” which was consistent with a diagnosis of inverted follicular keratosis (IFK) [Figure 2]. We started her on topical 5% imiquimod and are still awaiting another follow-up from her.
Figure 2: Histopathological report

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  Discussion Top

IFK is a benign skin lesion that typically presents as an asymptomatic, solitary nodule on the face of middle-aged and older individuals.[1] The lesion is around 0.3–1 cm in size and is more frequent in males. Histopathologically reveals as an endophytic tumor with large lobules or filiform projections of tumoral cells which progress toward the dermis. Exophytic growth is also detectable. A distinct microscopic feature is the squamous eddies in which whorled layers of squamous cells are evident and may lead to keratinization by producing keratohyalin or sometimes keratin spots in the center of these islands.[2]

The etiopathogenesis of IFK is not exactly known. Association with viral warts, seborrheic keratosis, human papillomavirus, and Cowden syndrome has been reported while some suggest that IFK is a neoplasm of follicular origin. Differential diagnosis includes viral warts, seborrheic keratosis, actinic keratosis, basal cell carcinoma, and squamous cell carcinoma. Surgical excision and 5% imiquimod are the common treatment modalities for IFK.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


We would like to thank our patient.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Shih CC, Yu HS, Tung YC, Tsai KB, Cheng ST. Inverted follicular keratosis. Kaohsiung J Med Sci 2001;17:50-4.  Back to cited text no. 1
Amoli FA, Alain A, Heidari AB, Jahanzad I. Detection of human papillomavirus infection in inverted follicular keratosis lesions of the eyelid by immunohistochemistry method. Acta Med Iran 2009;47:436-8.  Back to cited text no. 2
Karadag AS, Ozlu E, Uzuncakmak TK, Akdeniz N, Cobanoglu B, Oman B. Inverted follicular keratosis successfully treated with imiquimod. Indian Dermatol Online J 2016;7:177-9.  Back to cited text no. 3
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