Publish date: Posted on
Last updated: May 13, 2022
Keywords #
keratosis pilaris
KP
Diagnosis #
Keratosis Pilaris(KP)is a benign follicular disorder characterized by hyperkeratotic folliculocentric papules and variable levels of erythema. Lesions primarily occur symmetrically on the proximal, extensor aspects of the limbs, face, and buttocks.[1]
Key Concepts #
- Keratosis Pilaris is a common, benign skin condition that is considered a variant of the normal skin type.
- Keratosis Pilaris typically presents in childhood and may improve with age.
- The pathogenesis behind keratosis pilaris has not been fully elucidated but research shows it maybe related to filaggrin mutations [2]which lead to abnormal desquamation of keratinocytes and subsequent follicular plugging.
- There are several subtypes of keratosis pilaris including keratosis pilaris atrophicans faciei, atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans.
Epidemiology #
Keratosis Pilaris commonly presents in childhood and peaks in adolescence. 51%of patients develop KP in the first decade of life, and a further 35%, 12%and 2% in the second, third and fourth decades, respectively.[3]The incidence of keratosis pilaris does not differ between the sexes.[4]
Clinical Features #
- KP appears as spiny, keratotic papules with variable erythema involving the extensor aspects of proximal arms, thighs, and buttocks.
- Keratosis pilarisis seen increasingly in other conditions and syndromes such as atopic dermatitis, ichthyosis vulgaris, Noonan syndrome, diabetes, down syndrome, woolly hair, and obesity.
Differential Diagnoses #
- Benign lichenoid keratosis and lichen planus-like keratosis
- Folliculitis
- Milia
- Pityriasis rosea
- Phrynoderma
Diagnostic Workup #
Keratosis pilaris is primarily a clinical diagnosis and thus does not usually require a diagnostic work up beyond the history and physical exam. If histopathology is performed findings may include hyperkeratosis and mild perivascular lymphocytic infiltrate in the upper dermis. Dermoscopy may reveal twisted hairs forming loops and coils, as well as perifollicular papular erythema. [5]
Treatment #
No treatment is necessary for keratosis pilaris unless desired for cosmetic reasons. Treatment goals are aimed at reducing inflammation and improving the texture of the skin. Keratolytic lotions and creams containing salicylic acid, urea, and lactic acid can be used to decrease the rate of keratinization and subsequent follicular plugging. Second line therapy may include topical retinoid creams such as tretinoin 0.05% or adapalene 0.1%. Both classes of treatment options usually require several weeks to see improvement. Mixed results have been observed with the use of lasers as a potential third line treatment.
References #
- Hwang, Sharon, and Robert A Schwartz. “Keratosis pilaris: a common follicular hyperkeratosis.” Cutisvol. 82,3 (2008): 177-80.
- Landeck, Lilla et al. “Genotype-phenotype associations in filaggrin loss-of-function mutation carriers.” Contact dermatitisvol. 68,3 (2013): 149-55.
- Poskitt, L, and J D Wilkinson. “Natural history of keratosis pilaris.” The British journal of dermatologyvol. 130,6 (1994): 711-3.
- Dogra S, Kumar B. Epidemiology of skin diseases in school children: a study from northern India. Pediatr Dermatol. 2003;20(6):470-473.
- Sonthalia, Sidharth et al. “Dermoscopy of Keratosis Pilaris.” Indian dermatology online journalvol. 10,5 613-614.
