Keratosis Pilaris Clinical Presentation
- Author: Ally N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD more...
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.
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.
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.
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.
Note the additional images below
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 several ichthyoses, especially ichthyosis vulgaris and atopic dermatitis. Keratosis pilaris is more common in siblings and in twins.
Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis. 2008 Sep. 82(3):177-80. [Medline].
Sardana K, Relhan V, Garg V, Khurana N. An observational analysis of erythromelanosis follicularis faciei et colli. Clin Exp Dermatol. 2008 May. 33(3):333-6. [Medline].
Augustine M, Jayaseelan E. Erythromelanosis follicularis faciei et colli: relationship with keratosis pilaris. Indian J Dermatol Venereol Leprol. 2008 Jan-Feb. 74(1):47-9. [Medline].
Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. 1994 Jun. 130(6):711-3. [Medline].
Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007 Jun. 56(6):901-16; quiz 917-20. [Medline].
Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges. 2006 Apr. 4(4):319-23. [Medline].
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. 1985 Jun. 112(6):679-85. [Medline].
Jackson JB, Touma SC, Norton AB. Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?. W V Med J. 2004 Jan-Feb. 100(1):26-8. [Medline].
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. 1995 May. 131(5):556-60. [Medline].
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. 2009 Oct. 35(10):1592-5. [Medline].
Clark SM, Mills CM, Lanigan SW. Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser. J Cutan Laser Ther. 2000 Sep. 2(3):151-6. [Medline].
Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. 1984 Aug. 11(2 Pt 1):305-6. [Medline].