Keratosis Pilaris Clinical Presentation

Updated: Jun 15, 2017
  • Author: Ally N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Keratosis pilaris (KP) patients often report a rough texture (gooseflesh appearance) and overall poor cosmetic appearance of their skin. Eruptions are usually asymptomatic, except for occasional pruritus. Many people with keratosis pilaris are unaware the skin condition has a designated medical term or that it is treatable. In general, keratosis pilaris is often cosmetically displeasing but, medically, is completely harmless. Keratosis pilaris is frequently noted in otherwise healthy, asymptomatic patients visiting dermatologists and other physicians for unrelated skin conditions.

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Physical Examination

Physical findings of keratosis pilaris (KP) are limited to the skin. Upon gross examination, the skin of the outer-upper arms and thighs is frequently affected. The skin is described as chicken skin or goose-bumps. Often, 10-100 very small, slightly rough bumps are scattered in an area. Palpation may reveal a fine, sandpaper like texture to the area. Some of the bumps may be slightly red or have an accompanying light-red halo, indicating inflammation. In some instances, scratching away the surface of some bumps may reveal a small, coiled hair.

Small (up to 1-2 mm) folliculocentric keratotic papules are noted (see the image below). These are small bumps centered on small hair follicles. Some associated inflammation (erythema) may be present, and lesions may be the color of the skin. Often, a small, coiled hair can be seen beneath the papule. In other instances, a keratin plug or pimple like material may be expressed from each bump. Pustules and cysts are fairly rare.

Close-up view of keratosis pilaris. Keratotic foll Close-up view of keratosis pilaris. Keratotic follicular-based erythematous papules are noted on upper arm.

Commonly involved areas include posterolateral upper arms (see the image below), anterior thighs, buttocks, and facial cheeks. The single most characteristic area in keratosis pilaris is the upper-outer arms.

Keratosis pilaris in characteristic location on ou Keratosis pilaris in characteristic location on outer upper arm of a 30-year-old woman.

Ulerythema ophryogenes (keratosis pilaris atrophicans faciei) is described as an uncommon variant of keratosis pilaris characterized by follicular-based, small horny, red papules of the eyebrows and cheeks. This may be complicated and followed by a gradual loss of hair in the affected facial areas. [8]

Note the additional images below

Classic skin-colored bumps on upper arm of young w 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 femal 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 t 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 Keratosis pilaris on upper arm. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on upper arm of twin. Image cour Keratosis pilaris on upper arm of twin. Image courtesy of The Skin Center of Laguna.
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Causes

The etiology of keratosis pilaris (KP) is not fully known. The definite association of hyperkeratinization has been established. Of persons affected, 50-70% have a genetic predisposition. Dry skin conditions seem to exacerbate the disease. Symptoms generally tend to worsen in winter and improve in summer. Common associations include several ichthyoses, especially ichthyosis vulgaris and atopic dermatitis. [7] Keratosis pilaris is more common in siblings and in twins.

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