Clinical, Dermoscopic, and Histopathological Features of Follicular Keratotic Disorders: An Observational Cross-sectional Study
Eshmeet Sudan, Naina Kala Dogra, Bharti ThakerABSTRACT
Background:
Follicular keratotic disorders present with hyperkeratotic papules due to abnormal follicular keratinization, and overlapping features often hinder accurate diagnosis. Dermoscopy enables noninvasive visualization of subtle patterns, whereas histopathology, though confirmatory, is invasive and less favored in children. Few studies integrate clinical, dermoscopic, and histopathological findings; this study aims to bridge that gap
Aims:
To evaluate the clinical, dermoscopic, and histopathological features of follicular keratotic disorders, and identify dermoscopic diagnostic features that can aid in noninvasive diagnosis
Materials and Methods:
This hospitalbased, crosssectional, prospective study was conducted over 1 year on 70 cases with features suggestive of follicular keratotic disorders. Detailed history, clinical examination, dermoscopy (DermLite DL4), and histopathology were performed. Data were analyzed using OpenEpi
Results:
Mean age was 23.7 ± 14.99 years. The most common disorder was keratosis pilaris (35.71%), followed by phrynoderma (22.86%). Keratin plugs (85.71%), perifollicular scaling (78.57%), and white scales (77.14%) were the predominant dermoscopic findings. Histopathology most often revealed hyperkeratosis (92.86%), acanthosis (87.14%), and perivascular lymphocytic infiltrate (80%). Overall, dermoscopy demonstrated concordance with histopathology in approximately 74% of cases, with the highest agreement observed for follicular keratin plugs and perifollicular scaling
Limitations:
Despite a larger sample than prior studies, it remains small, limiting generalizability. Limited dermoscopic data for some disorders hinder pattern recognition. The cross-sectional design allows only a single time-point assessment
Conclusion:
Dermoscopy serves as a useful, noninvasive first-line adjunctive and triage tool in follicular keratotic disorders and may help guide the need for biopsy, especially in children. Histopathology remains essential for confirmation in equivocal cases.