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Lichen spinulosus is a clinically distinctive variant of keratosis pilaris. It is characterised by solitary or multiple patches of minute follicular papules, each centred by a horny spine that may occur on any part of the body. It is also called ‘keratosis spinulosa'.


Lichen spinulosus occurs during childhood to young adulthood, with most cases occurring during adolescence. It tends to have a sudden onset and is not accompanied by other signs and symptoms. The follicular papules are small rough bumps that appear in round or oval patches, which extend and spread rapidly over a few days to affect large areas of skin.

- Patches and plaques of follicular papules grow to between 2-5cm in diameter

- Patches develop symmetrically at intervals on the neck, buttocks, thighs, abdomen, knees and extensor surfaces of the arms

- Individual follicular papules are 1-3mm in diameter with a pointed or hair-like horny spine extending approximately 1mm around the tip of the follicle

When a patch is rubbed gently with the fingers, it has been likened to the feel of brushing your fingers over a nutmeg grater. The lesions do not cause any pain but some patients may complain of pruritus (itching).

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