Keratosis Pilaris

Zoltan Trizna, MD, PhD Reviewed 06/2017
Email

Send Email

Recipient(s) will receive an email with a link to 'Keratosis Pilaris' and will have access to the topic for 7 days.

Subject: Keratosis Pilaris

(Optional message may have a maximum of 1000 characters.)

×
 


BASICS

  • Keratosis pilaris (KP) is a benign skin disorder resulting in hyperkeratinization of the hair follicles.

  • Generally asymptomatic, often improving with age

DESCRIPTION

Small (1 to 2 mm), keratotic papules are localized to hair follicles, most frequently on the lateral aspects of the arms and thighs. Often described as chicken skin or goose bumps. 

EPIDEMIOLOGY

There is a slight female predominance. 

PREVALENCE

KP affects up to 80% of adolescents, often worsening during puberty, and up to 40% of adults. 

ETIOLOGY

  • The abrasive (“sandpaper-like,” “chicken skin-like,” or “goose bump-like”) texture of the skin is caused by excess buildup of keratin. An underlying hair may be found in some of the papules. In the inflammatory variant, mild perifollicular erythema is present.

  • Autosomal dominant inheritance, with incomplete penetrance. KP is more frequent in obese patients.

GENETICS

Autosomal dominant inheritance, with incomplete penetrance and variable expressivity, has been described, and many (30–50%) will report a positive family history of the disorder. 

GENERAL PREVENTION

Moisturize to prevent excessive drying of the skin. Use only mild soaps (cleansers). Avoid hot showers. 

ASSOCIATED CONDITIONS

Ichthyosis, xerosis, atopic dermatitis 

DIAGNOSIS

HISTORY

  • Patients often complain about a “rough” skin, sometimes with pruritus (which indicates inflammation).

  • Most patients are asymptomatic, but some are concerned about their cosmetic appearance.

  • Family history is positive in up to 50% of cases.

PHYSICAL EXAM

  • Firm, minimally rough, 1- to 2-mm, follicle-based papules, some with perilesional erythema. Distribution is frequently symmetric.

  • Most common on the lateral-proximal aspects of the arms and thighs; less common on the cheeks and gluteal areas

DIFFERENTIAL DIAGNOSIS

  • Acne

  • Folliculitis

  • Rare dermatologic conditions (e.g., keratosis follicularis, lichen spinulosus, lichen nitidus, perforating folliculitis)

TESTS

Diagnosis is visual. Dermoscopy may be of assistance if diagnosis is in doubt (1). 

DIAGNOSTIC PROCEDURES/SURGERY

Skin biopsy if diagnosis in doubt 

INTERPRETATION

Hyperkeratosis, hypergranulosis, and follicular plugging are typical. A mild superficial perivascular inflammatory infiltrate may be noted. 

TREATMENT

Daily measures to prevent dry skin, such as using mild cleansers, along with moisturizers, are the mainstay of treatment (2)[A]. Treatment improves symptoms but is not curative. 

GENERAL MEASURES

Moisturize. Use emollients. 

MEDICATION

FIRST LINE

  • Lactic acid 12% creams/lotions (e.g., ammonium lactate: AmLactin Ultra, Lac-Hydrin)

  • Urea (in 40–50% topical preparations)

SECOND LINE

Emollient-based topical steroids (e.g., Cloderm, Locoid Lipocream) 

ADDITIONAL THERAPIES

SURGERY

Microdermabrasion, laser (Nd:YAG, pulsed dye) 

ONGOING CARE

PROGNOSIS

Most cases improve with age. 

COMPLICATIONS

Hair loss is rare. If the lateral eyebrows are involved, consider the diagnosis of KP atrophicans faciei (ulerythema ophryogenes). 

REFERENCES

Panchaprateep R, Tanus A, Tosti A. Clinical, dermoscopic, and histopathologic features of body hair disorders. J Am Acad Dermatol.  2015;72(5):890–900.  [View Abstract]
Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis.  2008;82(3):177–180.  [View Abstract]

ADDITIONAL READING

Boza JC, Trindade EN, Peruzzo J et al. Skin manifestations of obesity: a comparative study. J Eur Acad Dermatol Venereol.  2012;26(10):1220–1223.  [View Abstract] 

CODES

ICD10

L85.8 Other specified epidermal thickening 

ICD9

  • 757.39 Other specified anomalies of skin

  • 701.1 Keratoderma, acquired

SNOMED

5132005 Keratosis pilaris (disorder) 

PEARLS

  • KP is frequently mistaken for acne.

  • Patients often self-manage with over-the-counter acne treatment products/medications originally prescribed for their facial acne.

  • Daily measures to prevent dry skin, such as using mild cleansers, along with moisturizers, are the mainstay of treatment.

  • Stop patients from exfoliating.

×