Pediatric Keratosis Pilaris Clinical Presentation

  • Author: Mark A Crowe, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 30, 2012
 

History

  • The patient with keratosis pilaris may report groups of keratotic papules, which feel rough and prickly. The patient may describe them as persistent, rough goose bumps. 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.
  • These lesions tend to improve after a few years.
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Physical

  • Keratosis pilaris alba is the more common variant and is characterized by small gray-white papules with a negligible inflammatory component.
  • Keratosis pilaris rubra has a significant inflammatory component; thus, patients present with small erythematous papules. More widespread areas of skin are involved. This variation is most conspicuous during the winter months.[3]
  • Observe for small, horny, follicular papules with (ie, rubra) or without (ie, alba) surrounding erythema.
  • Most commonly, lesions occur on the posterolateral upper arms and anterior thighs. Less commonly, lesions involve the face, buttocks, and trunk.
  • In involved areas, lesions are extensive, monomorphic, and very evenly spaced.
  • A fine hair may pierce the papules, or hair may be found coiled up within the keratin plug.
  • The keratin plug cannot be expressed with pressure.
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Causes

  • The etiology is unknown, although keratosis pilaris may be due to a disorder of corneocyte adhesion that prevents normal desquamation in the area around the follicle.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

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.

References

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

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

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

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

  5. Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. Aug 1984;11(2 Pt 1):305-6. [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. Barth JH, Wojnarowska F, Dawber RP. Is keratosis pilaris another androgen-dependent dermatosis?. Clin Exp Dermatol. Jul 1988;13(4):240-1. [Medline].

  8. Callaway SR, Lesher JL. Keratosis pilaris atrophicans: case series and review. Pediatr Dermatol. Jan-Feb 2004;21(1):14-7. [Medline].

  9. 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].

  10. Di Lernia V, Ricci C. Folliculitis spinulosa decalvans: an uncommon entity within the keratosis pilaris atrophicans spectrum. Pediatr Dermatol. May-Jun 2006;23(3):255-8. [Medline].

  11. Dogra S, Kumar B. Epidemiology of skin diseases in school children: a study from northern India. Pediatr Dermatol. Nov-Dec 2003;20(6):470-3. [Medline].

  12. Ehsani A, Namazi MR, Barikbin B, Nazemi MJ. Unilaterally generalized keratosis pilaris. J Eur Acad Dermatol Venereol. May 2003;17(3):361-2. [Medline].

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

  14. 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].

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

  16. Owen WR, Wood C. Disseminate and recurrent infundibulofolliculitis. Arch Dermatol. Feb 1979;115(2):174-5. [Medline].

  17. Ravikumar BC, Balachandran C, Shenoi SD, et al. Disseminate and recurrent infundibulofolliculitis: response to psoralen plus UVA therapy. Int J Dermatol. Jan 1999;38(1):75-6. [Medline].

  18. Rook A, Wilkinson DS, Ebling FJG, et al. Disorders of keratinization. In: Textbook of Dermatology. Oxford, England: Blackwell Publishers; 1986:1435-6.

  19. Zouboulis CC, Stratakis CA, Gollnick HP, Orfanos CE. Keratosis pilaris/ulerythema ophryogenes and 18p deletion: is it possiblethat the LAMA1 gene is involved?. J Med Genet. Feb 2001;38(2):127-8. [Medline]. [Full Text].

 
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Although other sites may be involved, keratosis pilaris is most common on the lateral upper arms and upper thighs.
Upon closer examination of keratosis pilaris, the lesions are very evenly spaced. This even distribution is consistent with the follicular origin of this disorder.
Close examination of keratosis pilaris shows keratotic papules associated with hair follicles. Keratinocytes normally shed from the surrounding skin become dust on the floor. Keratinocytes at the follicular orifice are retained, producing these papules.
Bacteria associated with the follicular papules of keratosis pilaris may cause some lesions to become erythematous or pustular.
This patient has lichen nitidus. Lichen nitidus is a differential diagnosis for keratosis pilaris. The papules of lichen nitidus tend to be flatter, and lesions develop in crops. Etiology of lichen nitidus is unknown.
Lichen nitidus also shows the property of koebnerization. Keratosis pilaris does not koebnerize.
Disseminate and recurrent infundibulofolliculitis is an uncommon slightly pruritic papular follicular eruption that affects the neck, face, trunk, and proximal extremities. It is a differential diagnosis for keratosis pilaris and occurs almost exclusively in blacks. The cause is unknown, and treatment has been totally unsuccessful. Disseminate and recurrent infundibulofolliculitis differs from keratosis pilaris in distribution and is less keratotic.
 
 
 
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