Pediatric Keratosis Pilaris Clinical Presentation
- Author: Derek H Chu, MD; Chief Editor: Dirk M Elston, MD more...
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.
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.
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.
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.
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.
Keratosis pilaris–like eruptions have been described in patients receiving targeted cancer therapies such as RAF inhibitors (ie, vemurafenib) and the Bcr-Abl tyrosine kinase inhibitor nilotinib.[9, 10]
Secondary bacterial infections can occur in traumatized lesions in individuals with keratosis pilaris.
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