Keratosis pilaris

Keratosis pilaris is a benign skin condition caused by increased keratinization and the formation of keratin plugs in hair follicles. It commonly affects children and adolescents and frequently improves with age. Keratosis pilaris manifests as dry, rough skin with small follicular papules and perifollicular erythema, typically on the facial cheeks and extensor surfaces of the proximal arms and thighs. Diagnosis is clinical. Treatment (e.g., emollients, keratolytics, topical retinoids) may be considered for symptomatic improvement and cosmesis. Laser therapy may be considered for refractory lesions.

• Can occur at any age
• Peak incidence during childhood and adolescence ^[1][2]

Epidemiological data refers to the US, unless otherwise specified.

• Not fully understood; may be associated with filaggrin mutations ^[3]
• Associated with atopic dermatitis and ichthyosis vulgaris ^[3][4]

Increased keratinization → keratin plug formation at follicle orifices

• Appearance of lesions ^[5][6]
  • Multiple rough, keratotic follicular papules or pustules (1–2 mm in diameter)
  • Skin-colored with perifollicular erythema
  • Most commonly located on the facial cheeks and extensor surface of the proximal arms and thighs ^[5][6]
• Associated symptoms: mild pruritus, dry skin, inflammation ^[1][7]
• Exacerbating factors: winter, pregnancy ^[1]

• Keratosis pilaris is a clinical diagnosis.
• Dermoscopy can support clinical findings.
• In case of diagnostic uncertainty, consider skin biopsy.

• Bacterial folliculitis
• Acne
• Pustular acne
• Heat rash
• Miliaria
• Pityriasis rubra pilaris

The differential diagnoses listed here are not exhaustive.

Treatment is usually not required as symptoms often improve with age. The following options may be considered for symptomatic relief and/or cosmesis. ^[1]

• All patients: Improve skin moisturization (e.g., use mild soaps and emollients; avoid long hot showers or baths).
• Extensive lesions
  • Keratolytics (e.g., lactic acid 10%, urea cream 20%) are preferred first-line agents. ^[1][2]
  • Topical retinoids (e.g., tazarotene 0.01%) may be considered for persistent lesions. ^[2]
• Significant inflammation: Consider short-term, low-potency topical steroids (e.g., hydrocortisone 2.5%, triamcinolone 0.1%). ^[1][2]
• Refractory symptoms: Refer to a dermatologist for management, which may include pulsed dye lasers and light therapy. ^[4]