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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

Look For

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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.

Best Tests

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Management Pearls

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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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Keratosis pilaris in Child
Keratosis pilaris : Cheek, Erythema, Follicular configuration, Thigh, Upper arm, Scaly papules
Clinical image of Keratosis pilaris
A close-up of follicularly-based, scaly, erythematous papules.
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