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Keratosis Pilaris

  • Author: Ally N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: May 10, 2016
 

Background

Keratosis pilaris (KP) is a genetic disorder of keratinization of hair follicles of the skin. It is an extremely common benign condition that manifests as small, rough folliculocentric keratotic papules, often described as chicken bumps, chicken skin, or goose-bumps, in characteristic areas of the body, particularly the outer-upper arms and thighs. Although no clear etiology has been defined, keratosis pilaris is often described in association with other dry skin conditions such as ichthyosis vulgaris, xerosis, and, less commonly, with atopic dermatitis, including conditions of asthma and allergies.[1]

Keratosis pilaris affects nearly 50-80% of all adolescents and approximately 40% of adults. It is frequently noted in otherwise asymptomatic patients visiting dermatologists for other conditions. Most people with keratosis pilaris are unaware the condition has a designated medical term or that it is treatable. In general, keratosis pilaris is frequently cosmetically displeasing but medically harmless.

Overall, keratosis pilaris is described as a condition of childhood and adolescence. Although it often becomes more exaggerated at puberty, it frequently improves with age. However, many adults have keratosis pilaris late into senescence. Approximately 30-50% of patients have a positive family history. Autosomal dominant inheritance with variable penetrance has been described.

Seasonal variation is sometimes described, with improvement of symptoms in summer months. Dry skin in winter tends to worsen symptoms for some groups of patients. Overall, keratosis pilaris is self-limited and, again, tends to improve with age in many patients. Some patients have lifelong keratosis pilaris with periods of remissions and exacerbations. More widespread atypical cases may be cosmetically disfiguring and psychologically distressing.

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Pathophysiology

Keratosis pilaris (KP) is a genetically based disorder of hyperkeratinization of the skin. An excess formation and/or buildup of keratin is thought to cause the abrasive goose-bump texture of the skin. In these patients, the process of keratinization (the formation of epidermal skin) is faulty. One theory is that surplus skin cells build up around individual hair follicles. The individual follicular bumps are often caused by a hair that is unable to reach the surface and becomes trapped beneath the keratin debris. Often, patients develop mild erythema around the hair follicles, which is indicative of the inflammatory condition. Often, a small, coiled hair can be seen beneath the papule. Not all the bumps have associated hairs underneath. Papules are thought to arise from excessive accumulation of keratin at the follicular orifice.

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Epidemiology

Frequency

Keratosis pilaris (KP) is overall a very common condition and is present worldwide. Keratosis pilaris affects 50-80% of adolescents and approximately 40% of adults worldwide.

In India and other countries, a specific condition called erythromelanosis follicularis faciei et colli is described. This is an unusual condition with a possible genetic or other relationship to keratosis pilaris. Erythromelanosis follicularis faciei et colli is characterized by the triad of hyperpigmentation, follicular plugging, and erythema of the face and neck.[2, 3]

Race

Keratosis pilaris (KP) has no widely described racial predilection or predominance. It is commonly noted worldwide in persons of all races.

Sex

Both sexes are affected by keratosis pilaris (KP), but females may be affected more frequently than males.[4]

Age

Age of onset of keratosis pilaris (KP) is often within the first decade of life; symptoms particularly intensify during puberty. However, keratosis pilaris may manifest in persons of any age and is common in young children. Some authorities believe individuals can outgrow the disorder by early adulthood, but often this is not the case.

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Prognosis

Overall prognosis is good. Many cases resolve with increasing age. However, others may persist into late adulthood with intermittent exacerbations and remissions.

Keratosis pilaris (KP) is not associated with increased mortality or morbidity. Often, patients are bothered by the cosmetic appearance of their skin and its rough, gooseflesh texture. Obesity has been implicated in a wide spectrum of dermatologic diseases, including keratosis pilaris.[5] Keratosis pilaris is commonly present in otherwise healthy individuals and does not have any known, long-term health implications.

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Patient Education

Patient education should focus on the tendency for chronicity of the condition and the need for ongoing maintenance therapy. Patients should also be advised that the condition is not contagious and is not a threat to their overall health. For patient education resources, see the Skin, Hair, and Nails Center.

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Contributor Information and Disclosures
Author

Ally N Alai, MD, FAAD Medical Director, The Skin Center at Laguna; Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine, School of Medicine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Expert Medical Reviewer, Medical Board of California; Expert Consultant, California Department of Consumer Affairs; Expert Reviewer, California Department of Registered Nursing

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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. 2008 Sep. 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. 2008 May. 33(3):333-6. [Medline].

  3. 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].

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

  5. 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].

  6. Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges. 2006 Apr. 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. 1985 Jun. 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. 2004 Jan-Feb. 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. 1995 May. 131(5):556-60. [Medline].

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

  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. 2009 Oct. 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. 2000 Sep. 2(3):151-6. [Medline].

  13. Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. 1984 Aug. 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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