eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Keratosis Pilaris: Differential Diagnoses & Workup

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Coauthor(s): Steven J Escobar, MD, Fellow, Division of Pulmonary and Critical Care Medicine, Naval Medical Center, San Diego
Contributor Information and Disclosures

Updated: Oct 12, 2009

Differential Diagnoses

Other Problems to Be Considered

  • Acne vulgaris
  • Pityriasis rubra pilaris
  • Folliculitis - Bacterial, fungal, or irritant
  • Lichen spinulosus
  • Phrynoderma
  • Keratosis pilaris atrophicans
  • Lichen nitidus
  • Disseminate and recurrent infundibulofolliculitis
  • Traumatic anserine folliculosis
  • Cutis anserina (gooseflesh)
  • Follicular atopic dermatitis

The papules of lichen nitidus tend to be flatter, and lesions develop in crops. 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 and occurs almost exclusively in black people. Disseminate and recurrent infundibulofolliculitis differs from keratosis pilaris in distribution and is less keratotic.

Workup

Laboratory Studies

  • Keratosis pilaris is clinically diagnosed by the appearance and distribution of the lesions.

Histologic Findings

  • The epidermis demonstrates a fine lamellar follicular plug arranged concentrically around a normal hair shaft.
  • The plug extends to the level of the hair follicle, and one or more rudimentary hairs may also be present.
  • Mild hyperkeratosis and hypogranulosis may also be noted.4

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. 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].

Further Reading

Keywords

keratosis pilaris alba, keratosis pilaris rubra, goose bumps, hair follicle, keratinized hair follicles, keratotic papule, perifollicular erythema, ichthyosis vulgaris, atopic dermatitis, hyperandrogenism, erythematous papules, corneocyte adhesion, hyperkeratosis, hypogranulosis

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, Fellow, 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, Society of Critical Care Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-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.

CME Editor

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 Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

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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