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Since she was about 2 years old, this now 14-year-old girl has had asymptomatic bumps on her arms and face. They are most noticeable in the wintertime and a bit less conspicuous during humid months. Besides the appearance of the lesions, the patient is annoyed by the rough feel of them, which is unaffected by her use of OTC moisturizers and lotions.
Her mother recalls having the same problem as a child but says it improved with time. The patient’s immediate family members are all atopic, with seasonal allergies and eczema.
EXAMINATION
The patient is Hispanic with type IV skin. Dense patches of brown, tiny, rough, papulofollicular lesions cover the surface of both posterior triceps. They are also visible on the patient’s anterior thighs and the posterior two-thirds of her face.
What is the diagnosis?
DISCUSSION
Keratosis pilaris (KP) is an inherited condition that affects 30% to 50% of all children without respect to race or gender. It can be a problem unto itself, or it can be part of the atopic diathesis in patients with seasonal allergies, dry skin, and eczema.
KP is caused by an excessive production of keratin that plugs the follicles, often trapping tiny fine hairs inside and resulting in a firm follicular papule. The distribution exhibited in this case is quite typical, as is the brown color on the patient’s arms (common in those with darker skin). KP can also affect the skin on other convex areas (eg, buttocks, deltoids, and thighs). It spares glabrous skin completely. A common variant is rubra facei, characterized by redness and bumps on the posterior two-thirds of the face.
Though it cannot be cured, the condition can be controlled with keratolytics containing salicylic acid, urea, or glycolic acid, or with pure emollients, which trap moisture in the skin. For the occasional itch, topical steroid creams or ointments can be helpful.
Patient education is a key aspect of treatment. Patients can be reassured of the condition’s benignancy, and they may be relieved to know that most KP patients see major improvement as they reach their third decade of life (and beyond).
TAKE-HOME LEARNING POINTS
- Keratosis pilaris (KP) is an extremely common condition inherited by autosomal dominant mode that affects more than 30% of children.
- Excessive keratin production is the cause of KP; it plugs follicular orifices, trapping fine hairs inside and causing crops of firm scaly papules to develop on triceps, deltoids, anterior thighs, and other areas (eg, the face).
- KP is considered part of the minor diagnostic criteria for atopy, but it can also be a standalone condition.
- Treatment of KP is far from perfect, but improvement is seen with the use of either keratolytics or emollients. Anything that dries it out more (eg, long, hot showers) or irritates individual lesions (eg, picking) is to be avoided.
- Most KP patients report improvement after the third decade of life.
Since she was about 2 years old, this now 14-year-old girl has had asymptomatic bumps on her arms and face. They are most noticeable in the wintertime and a bit less conspicuous during humid months. Besides the appearance of the lesions, the patient is annoyed by the rough feel of them, which is unaffected by her use of OTC moisturizers and lotions.
Her mother recalls having the same problem as a child but says it improved with time. The patient’s immediate family members are all atopic, with seasonal allergies and eczema.
EXAMINATION
The patient is Hispanic with type IV skin. Dense patches of brown, tiny, rough, papulofollicular lesions cover the surface of both posterior triceps. They are also visible on the patient’s anterior thighs and the posterior two-thirds of her face.
What is the diagnosis?
DISCUSSION
Keratosis pilaris (KP) is an inherited condition that affects 30% to 50% of all children without respect to race or gender. It can be a problem unto itself, or it can be part of the atopic diathesis in patients with seasonal allergies, dry skin, and eczema.
KP is caused by an excessive production of keratin that plugs the follicles, often trapping tiny fine hairs inside and resulting in a firm follicular papule. The distribution exhibited in this case is quite typical, as is the brown color on the patient’s arms (common in those with darker skin). KP can also affect the skin on other convex areas (eg, buttocks, deltoids, and thighs). It spares glabrous skin completely. A common variant is rubra facei, characterized by redness and bumps on the posterior two-thirds of the face.
Though it cannot be cured, the condition can be controlled with keratolytics containing salicylic acid, urea, or glycolic acid, or with pure emollients, which trap moisture in the skin. For the occasional itch, topical steroid creams or ointments can be helpful.
Patient education is a key aspect of treatment. Patients can be reassured of the condition’s benignancy, and they may be relieved to know that most KP patients see major improvement as they reach their third decade of life (and beyond).
TAKE-HOME LEARNING POINTS
- Keratosis pilaris (KP) is an extremely common condition inherited by autosomal dominant mode that affects more than 30% of children.
- Excessive keratin production is the cause of KP; it plugs follicular orifices, trapping fine hairs inside and causing crops of firm scaly papules to develop on triceps, deltoids, anterior thighs, and other areas (eg, the face).
- KP is considered part of the minor diagnostic criteria for atopy, but it can also be a standalone condition.
- Treatment of KP is far from perfect, but improvement is seen with the use of either keratolytics or emollients. Anything that dries it out more (eg, long, hot showers) or irritates individual lesions (eg, picking) is to be avoided.
- Most KP patients report improvement after the third decade of life.
Since she was about 2 years old, this now 14-year-old girl has had asymptomatic bumps on her arms and face. They are most noticeable in the wintertime and a bit less conspicuous during humid months. Besides the appearance of the lesions, the patient is annoyed by the rough feel of them, which is unaffected by her use of OTC moisturizers and lotions.
Her mother recalls having the same problem as a child but says it improved with time. The patient’s immediate family members are all atopic, with seasonal allergies and eczema.
EXAMINATION
The patient is Hispanic with type IV skin. Dense patches of brown, tiny, rough, papulofollicular lesions cover the surface of both posterior triceps. They are also visible on the patient’s anterior thighs and the posterior two-thirds of her face.
What is the diagnosis?
DISCUSSION
Keratosis pilaris (KP) is an inherited condition that affects 30% to 50% of all children without respect to race or gender. It can be a problem unto itself, or it can be part of the atopic diathesis in patients with seasonal allergies, dry skin, and eczema.
KP is caused by an excessive production of keratin that plugs the follicles, often trapping tiny fine hairs inside and resulting in a firm follicular papule. The distribution exhibited in this case is quite typical, as is the brown color on the patient’s arms (common in those with darker skin). KP can also affect the skin on other convex areas (eg, buttocks, deltoids, and thighs). It spares glabrous skin completely. A common variant is rubra facei, characterized by redness and bumps on the posterior two-thirds of the face.
Though it cannot be cured, the condition can be controlled with keratolytics containing salicylic acid, urea, or glycolic acid, or with pure emollients, which trap moisture in the skin. For the occasional itch, topical steroid creams or ointments can be helpful.
Patient education is a key aspect of treatment. Patients can be reassured of the condition’s benignancy, and they may be relieved to know that most KP patients see major improvement as they reach their third decade of life (and beyond).
TAKE-HOME LEARNING POINTS
- Keratosis pilaris (KP) is an extremely common condition inherited by autosomal dominant mode that affects more than 30% of children.
- Excessive keratin production is the cause of KP; it plugs follicular orifices, trapping fine hairs inside and causing crops of firm scaly papules to develop on triceps, deltoids, anterior thighs, and other areas (eg, the face).
- KP is considered part of the minor diagnostic criteria for atopy, but it can also be a standalone condition.
- Treatment of KP is far from perfect, but improvement is seen with the use of either keratolytics or emollients. Anything that dries it out more (eg, long, hot showers) or irritates individual lesions (eg, picking) is to be avoided.
- Most KP patients report improvement after the third decade of life.
