What are the other Names for this Condition? (Also known as/Synonyms)

• Helwig’s Inverted Follicular Keratosis
• IFK (Inverted Follicular Keratosis)

What is Inverted Follicular Keratosis? (Definition/Background Information)

• Inverted Follicular Keratosis (IFK) is a benign tumor of the skin , generally observed in middle-aged and older men
• It is a slow-growing and usually solitary tumor that occurs as a painless nodule in the head and neck region, mostly on the face
• The cause and risk factors for Inverted Follicular Keratosis are generally unknown
• In a majority of cases, no treatment in necessary, unless it causes severe signs and symptoms or presents cosmetic concerns (visually unappealing)
• A simple surgical excision of the tumor is considered curative. The prognosis for Inverted Follicular Keratosis is excellent with suitable treatment

Who gets Inverted Follicular Keratosis? (Age and Sex Distribution)

• Inverted Follicular Keratosis (IFK) can occur at any age, but is common during middle-to-older age
• Both males and females may be affected, though males are affected twice as often than females
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization of IFK has been reported

What are the Risk Factors for Inverted Follicular Keratosis? (Predisposing Factors)

• Currently, no risk factors have been identified for Inverted Follicular Keratosis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Inverted Follicular Keratosis? (Etiology)

The cause of development of Inverted Follicular Keratosis is largely unknown.

• Some researchers believe that it is a variant of verruca vulgaris, a benign skin wart which is caused by human papilloma virus (HPV). However, studies have not confirmed that Inverted Follicular Keratosis is caused by HPV
• Some researchers believe that IFK may be a type of seborrheic keratosis

Research is currently being undertaken to identify the relevant causal factors.

What are the Signs and Symptoms of Inverted Follicular Keratosis?

Inverted Follicular Keratosis is typically asymptomatic, indicating that they do not present any significant signs and symptoms. However, the following features may be observed:

• It usually occurs as a solitary raised nodule on the skin 
• It is a slow-growing tumor with an average size of 0.5-1.0 cm
• The nodule is usually painless and non-itchy. The lesion is mostly well-demarcated and firm to touch
• These nodules can occur anywhere in the body, but they are commonly observed in the head and neck region, frequently on the face (especially on the cheeks, upper lip, and eyelids)
• Inverted Follicular Keratosis can be sometimes confused with melanoma (a malignant skin tumor), because of their pigmented appearance

How is Inverted Follicular Keratosis Diagnosed?

A diagnosis of Inverted Follicular Keratosis may involve the following:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Inverted Follicular Keratosis?

Inverted Follicular Keratosis is an uncommon tumor that does not generally cause any significant complications. However, some individuals may have concerns regarding their cosmetic appearance, mainly due to the location of the tumor on the face.

How is Inverted Follicular Keratosis Treated?

The treatment of Inverted Follicular Keratosis may involve the following:

• In a majority of cases, removal of the tumor is not necessary, unless it causes bothersome signs and symptoms
• The treatment is a complete surgical excision, which can result in a cure
• Once the nodule is completely removed, it usually does not recur. An incomplete removal may result in its recurrence
• Cauterization (burning-off) of the nodule can be performed using an electrocautery device or laser

How can Inverted Follicular Keratosis be Prevented?

Currently, there are no known methods to prevent Inverted Follicular Keratosis occurrence.

What is the Prognosis of Inverted Follicular Keratosis? (Outcomes/Resolutions)

The prognosis for Inverted Follicular Keratosis is excellent with appropriate treatment, since it is a benign tumor.

Additional and Relevant Useful Information for Inverted Follicular Keratosis:

• There is no evidence to prove that oily foods and chocolate-based products have an influence on Inverted Follicular Keratosis formation
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse