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Keratosis pilaris in Adult
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Keratosis pilaris in Adult

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Contributors: Sarah N. Robinson MD, Susan Burgin MD
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Synopsis

Keratosis pilaris is an exceedingly common, benign skin disorder of the follicular orifice, commonly referred to as "gooseflesh." It is characterized by small follicular papules on the posterior upper arms and thighs due to the retention of keratin at the follicular opening. It is seen most frequently in children, adolescents, and young adults, and is particularly common in individuals with xerosis or underlying eczema. Dry weather may make these skin changes more pronounced. Frequently, there is a family history of the condition. Autosomal dominant inheritance with variable penetrance has been described.

While keratosis pilaris is typically asymptomatic, patients may be bothered by the texture or appearance of affected areas, especially in cases with extensive involvement or significant background erythema as in keratosis pilaris rubra. Keratosis pilaris tends to be refractory to most treatments with complete cure highly unlikely; however, the condition tends to improve with age.

Keratosis pilaris most often occurs as described above, but 3 rarer atrophic clinical variants also exist: keratosis pilaris atrophicans faciei, atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans. These entities have hyperkeratotic follicular papules with varying degrees of atrophy. Keratosis pilaris atrophicans faciei is characterized by erythematous hyperkeratotic papules distributed on the lateral third of the eyebrows in young children. Atrophoderma vermiculatum (also termed honeycomb atrophy) is characterized by atrophic pits in a reticulate or worm-eaten array localized to the face of older children. Keratosis follicularis spinulosa decalvans is a disorder characterized by widespread keratosis pilaris, scarring alopecia, and eye abnormalities.

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.

In addition, keratosis pilaris-like drug eruptions have been described in association with vemurafenib.

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

  • Folliculitis – look for larger pustules
  • Atopic dermatitis – assess flexural extremities, such as antecubital and popliteal fossae
  • Milia – look for white, chalky cores; tend to be fewer in number
  • Lichen spinulosus – often clustered, lacks symmetry of keratosis pilaris
  • Acne vulgaris – distribution and presence of comedones is often indicative
  • Pityriasis rubra pilaris – characterized by red-orange, scaly plaques with islands of sparing, often with palm / sole involvement
  • Darier disease – look for crusted papules in a seborrheic distribution
  • Kyrle disease – typical lesions have larger central keratotic plugs
  • Scurvy – look for perifollicular hemorrhage, corkscrew hairs
  • Phrynoderma (vitamin A deficiency) – assess for other signs of nutritional deficiency
Atrophic variants of keratosis pilaris (see Synopsis):

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.

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References

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Last Reviewed: 02/01/2017
Last Updated: 03/29/2017
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Keratosis pilaris in Adult
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Keratosis pilaris : Cheek, Erythema, Follicular configuration, Thigh, Upper arm, Scaly papules
Clinical image of Keratosis pilaris
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