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Keratosis pilaris in Infant/Neonate
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Keratosis pilaris in Infant/Neonate

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Contributors: Susan Burgin MD, Sarah N. Robinson MD
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Keratosis pilaris is an exceedingly common skin condition with retention of keratin at follicular openings. The condition most commonly presents within the first 2 years of life with affected areas on the cheeks, upper arms, and/or thighs. It is more common in individuals with underlying atopic dermatitis. Dry winter weather and humidity often worsen the condition.


L85.8 – Other specified epidermal thickening

5132005 – Keratosis pilaris

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Keratosis pilaris is rare in newborns, and alternative diagnoses should be strongly considered in patients with "congenital keratosis pilaris."
  • Atopic dermatitis and keratosis pilaris may coexist in the same location. If atopic dermatitis "will not clear" on the cheeks, extensor arms, or anterior thighs, palpation will reveal the highly characteristic firm and spiny individual papules of keratosis pilaris versus the diffuse, rough to scaly texture of atopic dermatitis.
  • Lichen nitidus lesions are multiple shiny, nonkeratotic papules in clusters and with koebnerization.
  • Folliculitis, infantile acne, neonatal acne (benign cephalic pustulosis), and miliaria present with smooth-surfaced pustules or vesicles, which are not follicularly based.
  • Milia are white and smooth nonfollicularly based papules that are much more common in the newborn period.
  • Lichen spinulosus consists of flat-topped to spiny follicular papules; however, unlike keratosis pilaris, they are grouped in annular clusters, preferentially involve the trunk in addition to the extremities, and lack the firm consistency of keratosis pilaris.
  • Keratosis pilaris atrophicans (atrophoderma vermiculatum, keratosis follicularis spinulosa decalvans, ulerythema ophryogenes) should be considered when keratosis pilaris is present at birth; located in the scalp, eyebrows, or other unusual locations; or is associated with alopecia or scarring.
  • Early phrynoderma (vitamin A deficiency) may be identical to keratosis pilaris but usually occurs on the buttocks and shoulders in addition to the extensor surfaces of the extremities. Moreover, an underlying nutritional deficiency should be obvious (failure to thrive, emaciated appearance, growth curves below the third percentile, and other systemic signs of specific nutritional deficiencies). Established phrynoderma tends to be more widespread with larger individual papules than in keratosis pilaris (1-3 mm) that coalesce into plaques.
  • Lichenification in patients with dark skin phototypes may have small, smooth papules without the characteristic distribution of keratosis pilaris.

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: 02/01/2017
Last Updated: 09/27/2017
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Keratosis pilaris in Infant/Neonate
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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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