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Keratosis Pilaris

Key Points

  • Keratosis pilaris (KP) is a common, often autosomal dominantly inherited benign disorder that presents with hyperkeratotic papules with a central spicule on facial cheeks, upper posterior arms, lateral thighs, and buttocks.
  • KP often presents in association with atopic dermatitis.
  • Facial and upper arm involvement may present a cosmetic problem for patients. Frictional folliculitis arising from areas of KP may result in increased erythema or pustules in the affected area.
  • Long-term management to reduce hyperkeratosis is the mainstay of the therapeutic strategy and sometimes improves cosmetic appearance. Several treatments reduce inflammation of KP lesions.

Introduction

Keratosis pilaris (KP) is an extremely common, often autosomal dominantly inherited disorder that usually does not require treatment. Keratosis pilaris is most frequently seen in association with atopic dermatitis. The classic skin lesions are small, monomorphous, hyperkeratotic papules with a central spicule, often with an erythematous base or overlying an erythematous patch. On biopsy, these lesions are characterized by keratinous follicular plugging with orthohyperkeratosis to create a follicular spicule. Typical sites of involvement include facial cheeks, upper posterior arms, lateral thighs, and buttocks, and involvement is almost always bilateral and symmetric. Involvement of the face and upper arms may be a significant cosmetic problem for patients, and frictional folliculitis can complicate KP on the buttocks and thighs. Folliculitis may present as development of increased erythema or pustules in the affected area. Since KP is a benign and non-curable skin condition, long-term management is the mainstay of the therapeutic strategy; cosmetic improvement and reduction of inflammation are the primary therapeutic goals.