Dear editor, Collect children with clinical features of keratotic papules on the mandible, with most cases lasting several years. Skin examination: multiple isolated but densely distributed keratotic papules are seen F I G U R E 1 (A) Clinical picture. (B) Dermoscopy: hair follicle dilation (black arrow); Hair follicle horn plug (white arrow); White scales around hair follicles (red arrows); Reddish brown unstructured area (green circle). (C) TAF RCM: follicle funnel-shaped dilatation, follicle horn plug (red arrow), no inflammatory cell infiltration; (D) Lichenia spinulosus RCM: follicle funnel-shaped dilatation, follicle horn plug (red arrow); High refraction in the middle of the funnel (yellow circle); Scattered inflammatory cell infiltration around (blue arrow).