Keratosis Pilaris Clinical Presentation

  • Author: Nili N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 23, 2012
 

History

Keratosis pilaris (KP) patients often report a rough texture (gooseflesh appearance) and overall poor cosmetic appearance of their skin. Eruptions are usually asymptomatic, except for occasional pruritus. Many people with keratosis pilaris are unaware the skin condition has a designated medical term or that it is treatable. In general, keratosis pilaris is often cosmetically displeasing but, medically, is completely harmless. Keratosis pilaris is frequently noted in otherwise healthy, asymptomatic patients visiting dermatologists and other physicians for unrelated skin conditions.

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Physical

Physical findings of keratosis pilaris (KP) are limited to the skin. Upon gross examination, the skin of the outer-upper arms and thighs is frequently affected. The skin is described as chicken skin or goose bumps. Often, 10-100 very small, slightly rough bumps are scattered in an area. Palpation may reveal a fine, sandpaper like texture to the area. Some of the bumps may be slightly red or have an accompanying light-red halo, indicating inflammation. In some instances, scratching away the surface of some bumps may reveal a small, coiled hair.

Small (up to 1-2 mm) folliculocentric keratotic papules are noted (see the image below). These are small bumps centered on small hair follicles. Some associated inflammation (erythema) may be present, and lesions may be the color of the skin. Often, a small, coiled hair can be seen beneath the papule. In other instances, a keratin plug or pimple like material may be expressed from each bump. Pustules and cysts are fairly rare.

Close-up view of keratosis pilaris. Keratotic follClose-up view of keratosis pilaris. Keratotic follicular-based erythematous papules are noted on upper arm.

Commonly involved areas include posterolateral upper arms (see the image below), anterior thighs, buttocks, and facial cheeks. The single most characteristic area in keratosis pilaris is the upper-outer arms.

Keratosis pilaris in characteristic location on ouKeratosis pilaris in characteristic location on outer upper arm of a 30-year-old woman.

Ulerythema ophryogenes (keratosis pilaris atrophicans faciei) is described as an uncommon variant of keratosis pilaris characterized by follicular-based, small horny, red papules of the eyebrows and cheeks. This may be complicated and followed by a gradual loss of hair in the affected facial areas.[6]

Note the additional images below

Classic skin-colored bumps on upper arm of young wClassic skin-colored bumps on upper arm of young white female twin. Image courtesy of The Skin Center of Laguna. Keratosis pilaris on the upper arm of a twin femalKeratosis pilaris on the upper arm of a twin female. Image courtesy of The Skin Center of Laguna. Keratosis pilaris bumps on arm of a white female tKeratosis pilaris bumps on arm of a white female twin. Image courtesy of The Skin Center of Laguna. Keratosis pilaris on upper arm. Image courtesy of Keratosis pilaris on upper arm. Image courtesy of The Skin Center of Laguna. Keratosis pilaris on upper arm of twin. Image courKeratosis pilaris on upper arm of twin. Image courtesy of The Skin Center of Laguna.
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Causes

The etiology of keratosis pilaris (KP) is not fully known. The definite association of hyperkeratinization has been established. Of persons affected, 50-70% have a genetic predisposition. Dry skin conditions seem to exacerbate the disease. Symptoms generally tend to worsen in winter and improve in summer. Common associations include a family history of keratosis pilaris, ichthyosis, or atopic dermatitis.[7] Keratosis pilaris is more common in siblings and in twins.

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Contributor Information and Disclosures
Author

Nili N Alai, MD, FAAD  Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California

Nili N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

We authors appreciate the clinical photos supplied as a courtesy of The Skin Center at Laguna.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Dena Thompson, MS, and Arash Michael Saemi, MD, to the development and writing of this article.

References

  1. Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis. Sep 2008;82(3):177-80. [Medline].

  2. Sardana K, Relhan V, Garg V, Khurana N. An observational analysis of erythromelanosis follicularis faciei et colli. Clin Exp Dermatol. May 2008;33(3):333-6. [Medline].

  3. Augustine M, Jayaseelan E. Erythromelanosis follicularis faciei et colli: relationship with keratosis pilaris. Indian J Dermatol Venereol Leprol. Jan-Feb 2008;74(1):47-9. [Medline].

  4. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. Jun 2007;56(6):901-16; quiz 917-20. [Medline].

  5. Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. Jun 1994;130(6):711-3. [Medline].

  6. Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges. Apr 2006;4(4):319-23. [Medline].

  7. Mevorah B, Marazzi A, Frenk E. The prevalence of accentuated palmoplantar markings and keratosis pilaris in atopic dermatitis, autosomal dominant ichthyosis and control dermatological patients. Br J Dermatol. Jun 1985;112(6):679-85. [Medline].

  8. Jackson JB, Touma SC, Norton AB. Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?. W V Med J. Jan-Feb 2004;100(1):26-8. [Medline].

  9. Kragballe K, Steijlen PM, Ibsen HH, et al. Efficacy, tolerability, and safety of calcipotriol ointment in disorders of keratinization. Results of a randomized, double-blind, vehicle-controlled, right/left comparative study. Arch Dermatol. May 1995;131(5):556-60. [Medline].

  10. Use of Lasers for Becker's Nevus and Keratosis Pilaris. J Cutan Aesthet Surg. Jul 2008;1(2):112. [Medline].

  11. Kaune KM, Haas E, Emmert S, Schon MP, Zutt M. Successful treatment of severe keratosis pilaris rubra with a 595-nm pulsed dye laser. Dermatol Surg. Oct 2009;35(10):1592-5. [Medline].

  12. Clark SM, Mills CM, Lanigan SW. Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser. J Cutan Laser Ther. Sep 2000;2(3):151-6. [Medline].

  13. Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. Aug 1984;11(2 Pt 1):305-6. [Medline].

 
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Close-up view of keratosis pilaris. Keratotic follicular-based erythematous papules are noted on upper arm.
Keratosis pilaris in characteristic location on outer upper arm of a 30-year-old woman.
Classic skin-colored bumps on upper arm of young white female twin. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on the upper arm of a twin female. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris bumps on arm of a white female twin. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on upper arm. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on upper arm of twin. Image courtesy of The Skin Center of Laguna.
 
 
 
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