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Pediatric Keratosis Pilaris Clinical Presentation

  • Author: Derek H Chu, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 07, 2014
 

History

Patients with keratosis pilaris may report having rough and prickly goose bumps on their skin. They are not painful or significantly pruritic in most patients. About half of all affected patients notice a worsening of symptoms in the winter months. Keratosis pilaris tends to improve over many years.

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Physical

Physical examination findings consist of ill-defined groups of small, skin-colored, keratotic, follicular papules, with (keratosis pilaris rubra) or without (keratosis pilaris alba) significant inflammation or perifollicular erythema, as shown below. Keratosis pilaris rubra tends to be more widespread than typical keratosis pilaris.[5]

Keratosis pilaris occurs most commonly on the late Keratosis pilaris occurs most commonly on the lateral upper arms and upper thighs.
The lesions of keratosis pilaris are evenly spaced The lesions of keratosis pilaris are evenly spaced, consistent with the follicular origin of this disorder.
Close examination of keratosis pilaris shows kerat Close examination of keratosis pilaris shows keratotic papules associated with hair follicles. Keratinocytes at the follicular orifice are retained, producing keratin plugs.

Occasionally, patients may develop acneiform pustules or cysts, as shown below. A fine hair may pierce the papules, or hair may be found coiled up within the keratin plug. The keratin plug usually cannot be expressed with pressure.

Bacteria associated with the follicular papules of Bacteria associated with the follicular papules of keratosis pilaris may cause some lesions to become erythematous or pustular.

The papules are predominantly located over the posterolateral upper arms and anterior thighs, though they can also involve the face, buttocks, and trunk less commonly. They tend to be monomorphic and evenly spaced.

A pronounced, widespread variant has been described in infants—papular, profuse, and precocious keratosis pilaris.[6]

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Causes

The etiology of keratosis pilaris is not completely known. Keratosis pilaris may be due to a disorder of corneocyte adhesion that prevents normal desquamation in the area around the hair follicle. It is often associated with xerosis, ichthyosis vulgaris, and atopy. Other conditions reportedly associated with keratosis pilaris include ichthyosis follicularis, ectodermal dysplasia, keratitis ichthyosis deafness (KID) syndrome, Down syndrome, and cardiofaciocutaneous syndrome.

Al-Maawali et al propose that the gene BTG1 is critical for the development of the distinctive keratosis pilaris observed in patients with interstitial deletion of 12q21-q22.[7]

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Contributor Information and Disclosures
Author

Derek H Chu, MD Clinical Assistant Professor, Department of Dermatology, Stanford University School of Medicine

Derek H Chu, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, American Medical Association, Society for Pediatric Dermatology

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.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

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

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

Acknowledgements

Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Steven J Escobar, MD Staff, Division of Pulmonary and Critical Care Medicine, Naval Medical Center, San Diego

Steven J Escobar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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

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

  3. Thomas M, Khopkar US. Keratosis pilaris revisited: is it more than just a follicular keratosis?. Int J Trichology. 2012 Oct. 4(4):255-8. [Medline].

  4. 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].

  5. Marqueling AL, Gilliam AE, Prendiville J, Zvulunov A, Antaya RJ, Sugarman J. Keratosis pilaris rubra: a common but underrecognized condition. Arch Dermatol. 2006 Dec. 142(12):1611-6. [Medline].

  6. Castela E, Chiaverini C, Boralevi F, Hugues R, Lacour JP. Papular, profuse, and precocious keratosis pilaris. Pediatr Dermatol. 2012 May-Jun. 29(3):285-8. [Medline].

  7. Al-Maawali A, Marshall CR, Scherer SW, Dupuis L, Mendoza-Londono R, Stavropoulos DJ. Clinical characteristics in patients with interstitial deletions of chromosome region 12q21-q22 and identification of a critical region associated with keratosis pilaris. Am J Med Genet A. 2014 Mar. 164(3):796-800. [Medline].

  8. Sallakachart P, Nakjang Y. Keratosis pilaris: a clinico-histopathologic study. J Med Assoc Thai. 1987 Jul. 70(7):386-9. [Medline].

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

  10. Gerbig AW. Treating keratosis pilaris. J Am Acad Dermatol. 2002 Sep. 47(3):457. [Medline].

  11. Breithaupt AD, Alio A, Friedlander SF. A comparative trial comparing the efficacy of tacrolimus 0.1% ointment with Aquaphor ointment for the treatment of keratosis pilaris. Pediatr Dermatol. 2011 Jul-Aug. 28(4):459-60. [Medline].

  12. Saelim P, Pongprutthipan M, Pootongkam S, Jariyasethavong V, Asawanonda P. Long-pulsed 1064-nm Nd:YAG laser significantly improves keratosis pilaris: a randomized, evaluator-blind study. J Dermatolog Treat. 2012 Mar 4. [Medline].

  13. Alcántara González J, Boixeda P, Truchuelo Díez MT, Fleta Asín B. Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases. J Eur Acad Dermatol Venereol. 2011 Jun. 25(6):710-4. [Medline].

 
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Keratosis pilaris occurs most commonly on the lateral upper arms and upper thighs.
The lesions of keratosis pilaris are evenly spaced, consistent with the follicular origin of this disorder.
Close examination of keratosis pilaris shows keratotic papules associated with hair follicles. Keratinocytes at the follicular orifice are retained, producing keratin plugs.
Bacteria associated with the follicular papules of keratosis pilaris may cause some lesions to become erythematous or pustular.
 
 
 
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