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<p>Inverted follicular keratosis (IFK) is a rare benign tumor differentiating toward the infundibular portion of the hair follicle, with an uncertain pathogenesis. Due to its nonspecific clinical presentation, it is often misdiagnosed, with definitive diagnosis relying on histopathology. We retrospectively analyzed 35 cases of IFK diagnosed over a 12-year period. The male-to-female ratio was 0.75:1, with a mean age of 55.2 years. Lesions were predominantly solitary papules on the head (74.3%). The most common clinical differential diagnosis included seborrheic keratosis (37.1%) and melanocytic nevus (28.6%). Histologically, the lesions consistently showed endophytic growth, and squamous eddies were identified in the majority of cases, often accompanied by varying degrees of squamoid differentiation. Hyperkeratosis and parakeratosis coexisted in 80.0% of cases. Following surgical excision, recurrence was rare (2.9%). This study highlights the clinical variability and diagnostic challenges of IFK, emphasizing the importance of histopathological examination for accurate diagnosis.</p>

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Clinical and histopathological features of inverted follicular keratosis: a retrospective study of 35 cases

  • 期刊论文

  • 发表日期：

    2026年7月3日

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  • Jun Li,
  • Jingyi Lu,
  • Zhixiang Hua,
  • Yu Chen,
  • Jiawei Cheng,
  • Qi Zhang,
  • Ting He

摘要

Inverted follicular keratosis (IFK) is a rare benign tumor differentiating toward the infundibular portion of the hair follicle, with an uncertain pathogenesis. Due to its nonspecific clinical presentation, it is often misdiagnosed, with definitive diagnosis relying on histopathology. We retrospectively analyzed 35 cases of IFK diagnosed over a 12-year period. The male-to-female ratio was 0.75:1, with a mean age of 55.2 years. Lesions were predominantly solitary papules on the head (74.3%). The most common clinical differential diagnosis included seborrheic keratosis (37.1%) and melanocytic nevus (28.6%). Histologically, the lesions consistently showed endophytic growth, and squamous eddies were identified in the majority of cases, often accompanied by varying degrees of squamoid differentiation. Hyperkeratosis and parakeratosis coexisted in 80.0% of cases. Following surgical excision, recurrence was rare (2.9%). This study highlights the clinical variability and diagnostic challenges of IFK, emphasizing the importance of histopathological examination for accurate diagnosis.