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Keratosis pilaris in Child
Other Resources UpToDate PubMed

Keratosis pilaris in Child

Contributors: Susan Burgin MD, Sarah N. Robinson MD
Other Resources UpToDate PubMed


Keratosis pilaris is an exceedingly common, benign skin disorder of the follicular orifice. Small follicular papules arise due to the retention of keratin at the follicular opening. The most commonly affected areas are the posterior upper arms and thighs, although cheeks and buttocks may also be involved. Keratosis pilaris is seen more frequently in children and adolescents. It is more common in atopic individuals and, frequently, there is a family history of the condition.

Keratosis pilaris tends to worsen during winter months, and it usually decreases after puberty. It is typically asymptomatic, but if treatment is attempted, the affected areas are often refractory.

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.

Clinical Variants


L85.8 – Other specified epidermal thickening

5132005 – Keratosis pilaris

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Atopic dermatitis
  • Lichen nitidus – Small, dome-shaped, smooth-surfaced, nonfollicular papules on the extremities, abdomen, and penis; koebnerization is present.
  • Acne vulgaris
  • Facial lesions may be confused with milia or acne – Milia are yellow-white, chalky, nonfollicular, hemispherical, smooth-surfaced papules. Acne is characterized by comedones, inflammatory papules, and pustules.
  • Folliculitis – Inflammatory tender follicular papules / pustules (with perilesional erythema).
  • Miliaria – Inflammatory follicular papules, vesicles, or pustules on the trunk or proximal extremities; keratosis pilaris is noninflammatory.
  • Pityriasis rubra pilaris
  • Lichen spinulosus – Grouped keratotic spiny follicular papules coalescing to form nummular or circular plaques on the trunk and extremities.
  • Phrynoderma (vitamin A deficiency) – Large individual keratotic horny papules on the buttocks, shoulders, and around the elbows and knees; there may be an underling nutritional deficiency.

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:01/31/2017
Last Updated:02/12/2020
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Patient Information for Keratosis pilaris in Child
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Contributors: Medical staff writer


Keratosis pilaris is a very common, harmless skin condition appearing as rough, whitish papules (small, solid bumps) on the upper arms and thighs, especially of children and young adults.

Individual lesions of keratosis pilaris begin when a hair follicle becomes plugged with keratin, a protein found in skin, hair, and nails.

Who’s At Risk

Keratosis pilaris can affect people of any age, race, and sex. It is more common in females.

Keratosis pilaris usually starts in early childhood (by age 10) and can worsen during puberty. However, it frequently improves or even goes away by early adulthood.

Keratosis pilaris can affect 50%-80% of teenagers and up to 40% of adults. Many people have a family history of keratosis pilaris. A large proportion of individuals with ichthyosis vulgaris (an inherited skin condition characterized by very dry, very scaly skin) also report having keratosis pilaris.

Signs & Symptoms

The most common locations for keratosis pilaris include the following:
  • Back of the upper arms
  • Front and sides of the thighs
  • Buttocks
  • Cheeks
Keratosis pilaris lesions are tiny (1 mm) white-to-gray bumps centered in the hair follicle. Sometimes a thin, red ring may surround the white bump, indicating inflammation. In darker skin colors, the red area around the bumps may be harder to see or may be darker brown. The bumps all look very similar to one another, and they are evenly spaced on the skin's surface.

Rarely, people with keratosis pilaris may experience mild itching.

Keratosis pilaris tends to improve in warmer, more humid weather, and it may worsen in colder, drier weather.

Self-Care Guidelines

There is no cure for keratosis pilaris, but its appearance can be improved. It is often helpful to keep the skin moist (hydrated) and to use mild, fragrance-free cleansers, with daily applications of moisturizer.

Creams and ointments are better moisturizers than lotions, and they work best when applied just after bathing, while the skin is still moist. The following over-the-counter products may be helpful:
  • Preparations containing alpha-hydroxy acids such as glycolic acid or lactic acid (eg, CeraVe SA Cream for Rough & Bumpy Skin)
  • Creams containing urea (eg, Cetaphil Rough & Bumpy Daily Smoothing Moisturizer)
  • Hydrocortisone (eg, Cortaid) 1% cream (if the areas are itchy)
Do not try to scrub the bumps away with a pumice stone or similar harsh material; these approaches may irritate the skin and worsen the condition. Similarly, try to discourage your child from scratching or picking at the bumps, as these actions can lead to bacterial infections or scarring.

When to Seek Medical Care

Keratosis pilaris is not a serious medical condition and it has no health implications. However, if self-care measures are not improving the appearance of the skin and it continues to bother your child, see a dermatologist or another medical professional, who may prescribe stronger treatments. If pus-filled bumps appear, that indicates a secondary bacterial infection, and it is also important to seek care if this occurs.


Keratosis pilaris usually improves with time. However, it is generally considered to be a long-lasting (chronic) skin condition. Treatments are aimed at controlling the rough bumps, not curing them. Keratosis pilaris bumps will come back if therapy is stopped.

To treat the bumps of keratosis pilaris, your child's medical professional may recommend a topical cream or lotion containing:
  • Prescription-strength alpha- or beta-hydroxy acids (glycolic acid, lactic acid, salicylic acid).
  • Prescription-strength urea (Carmol, Aluvea, Keralac).
  • A retinoid such as tretinoin (Retin-A) or tazarotene (Avage, Tazorac).
  • Prescription-strength hydrocortisone cream if inflammation is present.
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Keratosis pilaris in Child
A medical illustration showing key findings of Keratosis pilaris : Cheek, Erythema, Follicular configuration, Thigh, Upper arm
Clinical image of Keratosis pilaris - imageId=32898. Click to open in gallery.  caption: 'A close-up of follicularly-based, scaly, erythematous papules.'
A close-up of follicularly-based, scaly, erythematous papules.
Copyright © 2023 VisualDx®. All rights reserved.