Keratosis pilaris in Child
Alerts and Notices
Synopsis
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
- Nonatrophic variant with background erythema – keratosis pilaris rubra
- Atrophic variants – keratosis pilaris atrophicans faciei (ulerythema ophryogenes), atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans
Codes
ICD10CM:L85.8 – Other specified epidermal thickening
SNOMEDCT:
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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Therapy
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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.Subscription Required
References
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Last Reviewed:01/31/2017
Last Updated:02/12/2020
Last Updated:02/12/2020
Patient Information for Keratosis pilaris in Child
Overview
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
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)
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.Treatments
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.
Keratosis pilaris in Child