Keratosis pilaris in Adult
Alerts and Notices
SynopsisKeratosis 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.
L85.8 – Other specified epidermal thickening
5132005 – Keratosis pilaris
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
Drug Reaction DataBelow 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.
Patient Information for Keratosis pilaris in Adult
OverviewKeratosis pilaris is a very common skin condition appearing as rough, whitish papules (small, solid bumps) on the upper arms and thighs of children and young adults especially, although older adults can also be affected. These bumps arise when a hair follicle becomes plugged with keratin, a protein found in skin, hair, and nails. The bumps are sometimes described as feeling rough, or like "goose bumps" or "chicken skin."
When keratosis pilaris appears on the face, it can be mistaken for acne. However, acne creams will not make the keratosis pilaris better and may aggravate the bumps. A common mistake many people make is to try and scrub the bumps away, but this can make the condition worse. A medical professional can recommend creams that should improve the keratosis pilaris, and it often goes away on its own.
Who’s At RiskKeratosis pilaris can affect people of any age, race / ethnicity, and sex. It is more common in females and in people with sensitive skin.
Keratosis pilaris often develops by age 10 and can worsen during puberty or pregnancy. 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 the presence of keratosis pilaris.
Signs & SymptomsThe most common locations for keratosis pilaris include:
- Back of the upper arms.
- Front of the thighs.
- Cheeks, especially in children.
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 GuidelinesThere 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) cream 1% (if the areas are itchy)
When to Seek Medical CareKeratosis 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 you, see a dermatologist or another medical professional who may be able to 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.
TreatmentsKeratosis pilaris may improve with time. However, it is generally regarded as 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 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 Adult