Diagnostic Considerations

Keratosis pilaris (KP) may be associated with phrynoderma (vitamin A deficiency). Interestingly, a significant association has also been found between acquired ichthyosis and keratosis pilaris as common cutaneous manifestations in persons with type 1 diabetes.

Keratosis pilaris may resemble the following uncommon skin conditions:

Lichen spinulosus
Pityriasis rubra pilaris
Ulerythema ophryogenes (ulerythema)
Ichthyosis vulgaris
Eruptive vellus hair cysts
Erythromelanosis follicularis faciei et colli
Keratosis follicularis (Darier disease)
Kyrle disease
Lichen nitidus
Perforating folliculitis
Trichostasis spinulosa
Keratosis pilaris rubra

Differential Diagnoses

Acne Vulgaris
Eruptive Vellus Hair Cysts
Erythromelanosis follicularis faciei et colli
Folliculitis
Keratosis Follicularis (Darier Disease)
Keratosis pilaris atrophicans faciei
Keratosis pilaris rubra
Kyrle Disease
Lichen Nitidus
Lichen Spinulosus
Milia
Pediatric Atopic Dermatitis
Perforating Folliculitis
Pityriasis Rubra Pilaris
Trichostasis Spinulosa
Ulerythema ophryogenes
Xerosis

Workup

Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis. 2008 Sep. 82(3):177-80. [QxMD MEDLINE Link].
Cohen-Barak E, Danial-Farran N, Hammed H, Aleme O, Krauz J, Gavish E, et al. Desmoglein 4 Mutation Underlies Autosomal Recessive Keratosis Pilaris Atrophicans. Acta Derm Venereol. 2018 May 24. [QxMD MEDLINE Link].
Khetarpal S, Sood A, Billings SD. Nilontinib induced keratosis pilaris atrophicans. Dermatol Online J. 2016 Aug 15. 22 (8):[QxMD MEDLINE Link].
Wang JF, Orlow SJ. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol. 2018 Oct. 19 (5):733-757. [QxMD MEDLINE Link].
Jimenez-Cauhe J, Fernandez-Gonzalez P, Ortega-Quijano D, Fernandez-Nieto D, Saceda-Corralo D. Keratosis pilaris-like eruption induced by nilotinib. G Ital Dermatol Venereol. 2019 Jul 12. [QxMD MEDLINE Link].
Liu F, Yang Y, Zheng Y, Liang YH, Zeng K. Mutation and expression of ABCA12 in keratosis pilaris and nevus comedonicus. Mol Med Rep. 2018 Sep. 18 (3):3153-3158. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Sardana K, Relhan V, Garg V, Khurana N. An observational analysis of erythromelanosis follicularis faciei et colli. Clin Exp Dermatol. 2008 May. 33(3):333-6. [QxMD MEDLINE Link].
Augustine M, Jayaseelan E. Erythromelanosis follicularis faciei et colli: relationship with keratosis pilaris. Indian J Dermatol Venereol Leprol. 2008 Jan-Feb. 74(1):47-9. [QxMD MEDLINE Link].
Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. 1994 Jun. 130(6):711-3. [QxMD MEDLINE Link].
Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007 Jun. 56(6):901-16; quiz 917-20. [QxMD MEDLINE Link].
Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges. 2006 Apr. 4(4):319-23. [QxMD MEDLINE Link].
Jackson JB, Touma SC, Norton AB. Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?. W V Med J. 2004 Jan-Feb. 100(1):26-8. [QxMD MEDLINE Link].
Searle T, Ali FR, Al-Niaimi F. The versatility of azelaic acid in dermatology. J Dermatolog Treat. 2020 Aug 4. 1-11. [QxMD MEDLINE Link].
Zirwas MJ, Fichtel J. Chlorine Dioxide Complex Cleanser: A New Agent With Rapid Efficacy for Keratosis Pilaris. J Drugs Dermatol. 2018 May 1. 17 (5):554-556. [QxMD MEDLINE Link].
Maghfour J, Ly S, Haidari W, Taylor SL, Feldman SR. Treatment of keratosis pilaris and its variants: a systematic review. J Dermatolog Treat. 2020 Sep 14. 1-12. [QxMD MEDLINE Link].
Kechichian E, Jabbour S, El Hachem L, Tomb R, Helou J. Light and Laser Treatments for Keratosis Pilaris: A Systematic Review. Dermatol Surg. 2020 Aug 7. [QxMD MEDLINE Link].
Kragballe K, Steijlen PM, Ibsen HH, et al. Efficacy, tolerability, and safety of calcipotriol ointment in disorders of keratinization. Results of a randomized, double-blind, vehicle-controlled, right/left comparative study. Arch Dermatol. 1995 May. 131(5):556-60. [QxMD MEDLINE Link].
Use of Lasers for Becker's Nevus and Keratosis Pilaris. J Cutan Aesthet Surg. 2008 Jul. 1(2):112. [QxMD MEDLINE Link]. [Full Text].
Kaune KM, Haas E, Emmert S, Schon MP, Zutt M. Successful treatment of severe keratosis pilaris rubra with a 595-nm pulsed dye laser. Dermatol Surg. 2009 Oct. 35(10):1592-5. [QxMD MEDLINE Link].
Clark SM, Mills CM, Lanigan SW. Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser. J Cutan Laser Ther. 2000 Sep. 2(3):151-6. [QxMD MEDLINE Link].
Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. 1984 Aug. 11(2 Pt 1):305-6. [QxMD MEDLINE Link].

Media Gallery

Close-up view of keratosis pilaris. Keratotic follicular-based erythematous papules are noted on upper arm.
Keratosis pilaris in characteristic location on outer upper arm of a 30-year-old woman.
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 female. Image courtesy of The Skin Center of Laguna.
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 The Skin Center of Laguna.
Keratosis pilaris on upper arm of twin. Image courtesy of The Skin Center of Laguna.

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Author

Ally N Alai, MD, FAAD Medical Director, The Skin Center at Laguna; Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine, School of Medicine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Expert Medical Reviewer, Medical Board of California; Expert Consultant, California Department of Consumer Affairs; Expert Reviewer, California Department of Registered Nursing

Ally N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society for MOHS Surgery

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.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

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

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

We authors appreciate the clinical photos supplied as a courtesy of The Skin Center at Laguna.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Dena Thompson, MS, and Arash Michael Saemi, MD, to the development and writing of this article.

Sections Keratosis Pilaris
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Keratosis Pilaris Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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