Keratins are heteropolymeric proteins which fortn the intermediate filament eytoskeleton in epithelial cells, Sinee 1991, mutations in several keratin genes have been found to cause a variety of human diseases affeeting the epidermis and other epithelial structures. Epidermolysis bullosa simplex (EBS) was the first mechanobullous disease for which the underlying genetic lesion was found, with mutations in both the K5 and K14 genes rendering basal epidermal keratinoeytes less resilient to trauma, resulting in skin fragility. The site of mutation in the keratin protein correlates with phenotypie severity in this disorder. Since tnutations were identified in the basal eell keratins, the total nutrtber of keratin genes associated with diseases has risen to eleven. The rod domains of suprabasal keratins Kl and K 10 are mutated in buUous congenital ichthyosiform erythroderma (BCIE; also ealled epidermolytic hyperkeratosis, EH) and mosaieism for Kl/KlO mutations results in a nevoid distribution of EH, An utiusual mutation in the VI domain of Kl has also been found to cause diffuse non-epidermolytie pahnoplantar keratodertna (DNEPPK), Mutations in pahnoplantar speeifie keratin K9 cause epidertnolytic pahnoplantar keratoderma (EPPK) and mutations in the late differentiation suprabasal keratin l<.2e cause iehthyosis tiullosa of Siemens (IBS). In the last year or so, mutations were discovered in differentiation speeifie keratins K6a and K16 eausing pachyonychia eongenita type 1 and KI 7 mutations occur in pachyonychia eongenita type 2, K16 and K17 mutations have also been reported to produee phenotypes with little or no nail changes: K16 tnutations can present as focal non-epidermolytic pahnoplantar keratodertna (NEPPK) and K17 mutations can result in a phenotype resembling steatoeystoma multiplex, Reeently, mutation of mueosal keratin pair K4 and K13 has been shown to underlie white sponge nevus (WSN), This year, the ftrst mutations in a keratin-associated protein, plectin, were shown to cause a variant of epidertnolysis bullosa associated with late-onset muscular dystrophy (MD-EBS), An unusual mutation has been identified in K5 which is responsible for EBS with mottled pigmentation and genetic linkage analysis suggests that the hair disorder monilethrix is likely to be due to a tnutation in a hair keratin. The study of keratin diseases has led to a better understanditig of the itnportanee of the intermediate filament cytoskeletoti and associated cotinector tnolecules iti tnaintaining the structural integrity of the epidermis and other high stress epithelial tissues, as well as allowing diagnosis at the molecular level thus facilitating prenatal testing for this heterogeneous group of genodertnatoses.