LS tends to have a sudden onset and is not accompanied by other signs or symptoms. The keratotic papules group into large plaques that can spread rapidly to affect large areas of skin. Patches and plaques of follicular papules have a diameter that ranges from 2-5 cm. Patches are distributed symmetrically over the integument. Patches affect the neck, buttocks, abdomen, trochanters, knees, and extensor surfaces of the arms.
Individual papules are flat to conical.
Individual papules usually are small, approximately 1-3 mm in diameter. Papules have a pointed or hairlike horny spine that extends approximately 1 mm around the tip of the follicle. When a patch is rubbed gently with the fingers, it feels similar to a nutmeg grater. Infection has been postulated, but no data support this hypothesis. Other authors have suggested that LS is part of atopy, but no association of LS with atopy was found in the Philippines.