Keratosis pilaris in Adult
While keratosis pilaris is typically asymptomatic, patients may be bothered by the texture or appearance of affected areas, especially in cases with extensive involvement or significant background erythema as in keratosis pilaris rubra. Keratosis pilaris tends to be refractory to most treatments with complete cure highly unlikely; however, the condition tends to improve with age.
Keratosis pilaris most often occurs as described above, but 3 rarer atrophic clinical variants also exist: keratosis pilaris atrophicans faciei, atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans. These entities have hyperkeratotic follicular papules with varying degrees of atrophy. Keratosis pilaris atrophicans faciei is characterized by erythematous hyperkeratotic papules distributed on the lateral third of the eyebrows in young children. Atrophoderma vermiculatum (also termed honeycomb atrophy) is characterized by atrophic pits in a reticulate or worm-eaten array localized to the face of older children. Keratosis follicularis spinulosa decalvans is a disorder characterized by widespread keratosis pilaris, scarring alopecia, and eye abnormalities.
Keratosis pilaris is seen with increased incidence in several syndromes and disease states. In addition to atopic dermatitis, these include ichthyosis vulgaris, erythromelanosis follicularis faciei et colli (erythema, brown pigmentation, and keratosis pilaris), Graham-Little-Piccardi-Lassueur syndrome (cicatricial alopecia of the scalp, loss of pubic and axillary hairs, and keratosis pilaris), cardiofaciocutaneous syndrome, Noonan syndrome, diabetes, Down syndrome, woolly hair, and obesity.
In addition, keratosis pilaris-like drug eruptions have been described in association with vemurafenib.
L85.8 – Other specified epidermal thickening
5132005 – Keratosis pilaris
Differential Diagnosis & Pitfalls
- Folliculitis – look for larger pustules
- Atopic dermatitis – assess flexural extremities, such as antecubital and popliteal fossae
- Milia – look for white, chalky cores; tend to be fewer in number
- Lichen spinulosus – often clustered, lacks symmetry of keratosis pilaris
- Acne vulgaris – distribution and presence of comedones is often indicative
- Pityriasis rubra pilaris – characterized by red-orange, scaly plaques with islands of sparing, often with palm / sole involvement
- Darier disease – look for crusted papules in a seborrheic distribution
- Kyrle disease – typical lesions have larger central keratotic plugs
- Scurvy – look for perifollicular hemorrhage, corkscrew hairs
- Phrynoderma (vitamin A deficiency) – assess for other signs of nutritional deficiency
Drug Reaction Data