Keratosis pilaris in Infant/Neonate
L85.8 – Other specified epidermal thickening
5132005 – 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.