eMedicine Specialties > Dermatology > Diseases of the Adnexa

Keratosis Pilaris: Differential Diagnoses & Workup

Author: Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty 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
Coauthor(s): Dena Thompson, MS, Boston University School of Medicine; Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego; Raul Del Rosario, MD, Consulting Staff, Surgical Pathology and Dermatopathology, South Coast Medical
Contributor Information and Disclosures

Updated: Oct 16, 2009

Differential Diagnoses

Acne Vulgaris
Lichen Nitidus
Atopic Dermatitis
Lichen Spinulosus
Eruptive Vellus Hair Cysts
Milia
Erythromelanosis follicularis faciei et colli
Perforating Folliculitis
Folliculitis
Pityriasis Rubra Pilaris
Keratosis Follicularis (Darier Disease)
Trichostasis Spinulosa
Keratosis pilaris atrophicans faciei
Ulerythema ophryogenes
Keratosis pilaris rubra
Xerosis
Kyrle Disease

Other Problems to Be Considered

Keratosis pilaris (KP) may be associated with phrynoderma (vitamin A deficiency). Interestingly, a significant association has also been found between acquired ichthyosis and keratosis pilaris as common cutaneous manifestations in persons with type 1 diabetes.

Keratosis pilaris may resemble the following uncommon skin conditions:

Workup

Laboratory Studies

No specific laboratory tests aid in the diagnosis of keratosis pilaris (KP). The diagnosis of keratosis pilaris is very straightforward and is based on a typical skin appearance in areas such as the upper arms. A family history of keratosis pilaris is also very helpful because keratosis pilaris has a strong genetic component. The diagnosis is confirmed on the basis of the physician’s clinical examination findings. A few other medical conditions look similar to keratosis pilaris, and these must be excluded.

Imaging Studies

Imaging studies are not indicated.

Procedures

Skin biopsy with histopathological examination may be useful in atypical cases.

Histologic Findings

Microscopic examination (histopathology) of keratosis pilaris (KP) lesions shows the triad of epidermal hyperkeratosis, hypergranulosis, and plugging of individual hair follicles. The upper dermis may have mild superficial perivascular lymphocytic inflammatory changes.

The individual papules in keratosis pilaris are thought to arise from excessive accumulation of keratin at the follicular orifice. The overlying epidermis shows mild thickening and plugging of the small follicular orifice.

More on Keratosis Pilaris

Overview: Keratosis Pilaris
Differential Diagnoses & Workup: Keratosis Pilaris
Treatment & Medication: Keratosis Pilaris
Follow-up: Keratosis Pilaris
Multimedia: Keratosis Pilaris
References

References

  1. 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].

  2. 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].

  3. 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].

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

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

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

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

  12. Lateef A, Schwartz RA. Keratosis pilaris. Cutis. Apr 1999;63(4):205-7. [Medline].

Further Reading

Keywords

keratosis pilaris, keratosis pilaris treatment, KP, hyperkeratosis, folliculocentric keratotic papules, follicular keratotic papules, atopic dermatitis, ichthyosis vulgaris, excessive accumulation of keratin, benign skin lesion, Ulerythema ophryogenes, keratosis pilaris atrophicans faciei, gooseflesh appearance, erythema, chickenskin bumps, chicken skin, goosebumps.

Contributor Information and Disclosures

Author

Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty 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.

Coauthor(s)

Dena Thompson, MS, Boston University School of Medicine
Disclosure: Nothing to disclose.

Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego
Arash Michael Saemi, MD is a member of the following medical societies: American College of Physicians, Radiological Society of North America, Sigma Xi, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Raul Del Rosario, MD, Consulting Staff, Surgical Pathology and Dermatopathology, South Coast Medical
Raul Del Rosario, MD is a member of the following medical societies: American Society for Clinical Pathology
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

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: Nothing to disclose.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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