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Keratosis Pilaris

Article
Skin Care
Diseases & Conditions
+1
Contributed byLester Fahrner, MD+1 moreMay 19, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • KP (Keratosis Pilaris)
  • Lichen Pilaris
  • Plucked Chicken Skin

What is Keratosis Pilaris? (Definition/Background Information)

  • Keratosis Pilaris (KP) is a very common skin condition that results in the formation of small bumps on the skin, usually on the arms and legs. The appearance of the skin is characteristically described as ‘plucked chicken’ skin
  • The cause of Keratosis Pilaris is unknown, but it develops when hair follicles get plugged by dead skin. Some cases are noted to have an autosomal dominant type of genetic inheritance
  • The risk factors for the condition include a positive family history, obesity, individuals with other skin conditions, such as ichthyosis vulgaris and atopic dermatitis, and the administration of certain medication for melanoma
  • A diagnosis of Keratosis Pilaris is made by clinical exam and various other diagnostic tools including dermoscopy and wood’s lamp examination
  • The treatment of Keratosis Pilaris includes the use of topical moisturizers, steroids, and surgical procedures such as dermabrasion. However, a majority of the affected individuals do not require any treatment
  • The prognosis of Keratosis Pilaris with adequate treatment is excellent, since generally it is a harmless condition

There are different types of Keratosis Pilaris and these include:

  • Atrophoderma Vermiculata (or Folliculitis Ulerythematosa Reticulata): This condition affects the skin resulting in pitted scarring of the cheek, which can cause cosmetic disfigurement
  • Erythromelanosis Follicularis Faciei Et Colli: It usually affects the face and neck region
  • Keratosis Follicularis Spinulosa Decalvans: It occurs on the scalp
  • Keratosis Pilaris Atrophicans Faciei: The condition usually affects the face
  • Ulerythema Ophryogenes: The eyebrows are typically affected

Who gets Keratosis Pilaris? (Age and Sex Distribution)

  • Keratosis Pilaris is generally observed in children (below the age of 5 years) and teenagers. However, individuals of a wider age range may be affected
  • In some individuals, the signs and symptoms may appear during adulthood; while in others, the signs and symptoms may last into adulthood
  • The condition affects both males and females, although a slight female preference is observed
  • It is seen worldwide and all racial and ethnic groups may be affected

What are the Risk Factors for Keratosis Pilaris? (Predisposing Factors)

The risk factors for Keratosis Pilaris include the following:

  • A positive family history: Only 1 in 3 individuals with KP have a family history of the condition
  • Individuals with dry skin, such as those with eczema (particularly atopic dermatitis)
  • Being overweight or obese
  • Individuals with asthma
  • Presence of ichthyosis vulgaris (a skin condition)
  • Individuals on medication called vemurafenib:
    • It is a drug that is used to treat malignant melanoma
    • In a majority of cases, the benefits of using the drug far outweigh its side effects, and the drug usage is not discontinued
    • Usually, individuals get KP at the beginning of vemurafenib treatment for melanoma
  • Twins: If one twin gets the condition, the other twin is also prone to get it
  • Severe allergies including hay fever
  • Pregnancy: Even though it is not a risk factor, the skin condition may become worse during pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Keratosis Pilaris?

Keratosis Pilaris is caused by the plugging of hair follicles by increased keratin debris (dead skin) on certain areas of the body. However, the factors that cause the condition are unknown or remain unidentified.

  • In individuals with a family history of Keratosis Pilaris, the condition may be inherited in an autosomal dominant manner. However, a majority of KP are sporadic and do not occur against a familial background
  • There is no definitive proof that certain types of diet play a role in the development of this skin condition. Taking chocolates or oily food materials are not known to cause the condition
  • KP is non-contagious and it does not spread from one individual to another. In other words, one cannot contract the condition by interacting closely with the affected individuals. It is not a sexually-transmitted disease

Autosomal dominant: Autosomal dominant conditions are traits or disorders that are present when only one copy of the mutation is inherited on a non-sex chromosome. In these types of conditions, the individual has one normal copy and one mutant copy of the gene. The abnormal gene dominates, masking the effects of the correctly functioning gene. If an individual has an autosomal dominant condition, the chance of passing the abnormal gene on to their offspring is 50%. Children, who do not inherit the abnormal gene, will not develop the condition or pass it on to their offspring.

What are the Signs and Symptoms of Keratosis Pilaris?

The signs and symptoms associated with Keratosis Pilaris may include:

  • The presence of small elevated benign lesions that appear like a patch of tiny goose bumps
  • This condition can involve the skin anywhere on the body, and it may look like small pimples. However, the condition is not ‘acne’
  • Although, the bumps are mostly observed on the arms and legs (upper arms and front part of the thigh). It can also be present on the face and neck (cheek) and buttocks
  • The palms of the hands and soles of the feet are generally not involved
  • In a majority of cases, no significant symptoms are observed and no itching or pain is generally noted
  • The skin feels like sandpaper, and occasionally they can itch
  • There can be redness of skin around the rashes or bumps (erythema)
  • The bumps can either take the surrounding skin color, or even be darker than the surrounding skin color (hyperpigmented)
  • In individuals with a positive family history of KP, a bilateral and symmetrical distribution of the lesions are observed (affecting both the right and left side)

Aggravation of the condition may occur under the following circumstances:

  • In children, the signs and symptoms may become worse during puberty
  • In dry, low-humid conditions, the symptoms may aggravate because of skin dryness. It may get better during summer and worse during dry winter months, due to a lack of humidity
  • Tanning of the skin through sun exposure
  • Shaving or waxing of skin
  • Dry sauna can also aggravate this skin condition

Note: Individuals, nearer to the tropics, may see the condition remain the same without any seasonal variations (all year long).

How is Keratosis Pilaris Diagnosed?

The diagnosis of Keratosis Pilaris may involve:

  • A complete evaluation of medical history along with a thorough examination of the skin lesions by a dermatologist
  • The healthcare provider may also ask many questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical conditions, infections, etc.
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Complete blood count (CBC)
  • Examination of peripheral blood smear under a microscope by a pathologist
  • If secondary infections develop, then a culture test may be done
  • In very rare cases, a skin biopsy may be performed: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: If itching is a prominent symptom, then other conditions, such as fungal infections, should be ruled out.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Keratosis Pilaris?

Complications associated with Keratosis Pilaris include:

  • Increased psychological stress due to the skin condition
  • Cosmetic issues: The skin may be hypopigmented or hyperpigmented and cause cosmetic issues
  • The skin over the lesions may become thin (atrophic)
  • Hair loss: With time, it can become permanent in the area of the skin lesions
  • Scratching the skin lesions may result in scars on healing
  • The signs and symptoms may appear and disappear, even with treatment. The condition can recur

How is Keratosis Pilaris Treated?

There is no definite cure for Keratosis Pilaris after onset of the signs and symptoms. Nevertheless, a majority of the individuals do not require treatment due to the absence of significant signs and symptoms.

The treatment options for Keratosis Pilaris may include both medical and surgical treatment measures.

  • The medical treatment for Keratosis Pilaris may include:
    • Avoiding hot dry environment
    • Use of moisturizers with urea or lactic acid
    • Topical medicated creams may be administered to remove dead skin (exfoliation therapy). The common medications used include lactic acid, vitamin D, and salicylic acid
    • Use of topical retinoids (tretinoin) and steroids
  • The surgical care for Keratosis Pilaris may include:
    • Dermabrasion: It is a surgical procedure to treat KP causing cosmetic issues
    • Laser therapy: Despite all the above treatment measures, if no improvement is noted, then laser therapy may be employed

Note:

One has to be patient for the signs and symptoms to get better, since it may take months before showing any improvement. Once the treatment has started, one has to be consistent in following the prescriptions and taking the medications continuously and regularly. Skipping the treatment regimen will not help improve the condition

The following tips are helpful for Keratosis Pilaris:

  • Keeping the skin moist can help in reducing the signs and symptoms caused by KP
  • If any of the prescribed treatment causes new stinging or burning symptoms, then it is important to stop using them immediately and inform the physician’s office
  • Taking care of oneself, being clean and hygienic (especially face and hands), avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that may help ensure a faster recovery from the condition
  • Avoid excessive washing and scrubbing of the skin; also limit time spent in water
  • Completely avoid scratching the affected areas

How can Keratosis Pilaris be Prevented?

Currently, there are no specific methods or guidelines to prevent Keratosis Pilaris. However, in order to prevent aggravation of the condition, the following steps may be considered:

  • Use of home humidifiers, in case of dry indoor air
  • Use moisturizing creams regularly to prevent dry skin
  • Use mild bathing soaps to not aggravate the condition
  • Avoid excessive, long duration baths using hot water
  • While showering do not use rough scrubbers, it can make the condition worse
  • Avoid tanning of the skin
  • Avoid shaving or skin waxing

What is the Prognosis of Keratosis Pilaris? (Outcomes/Resolutions)

  • The prognosis of Keratosis Pilaris is excellent in a majority of cases, since it is a benign/harmless condition
  • In many cases, KP only presents certain cosmetic issues and suitable treatment measures can help address the concern
  • In some individuals, the condition may clear without any treatment. In some individuals, KP signs and symptoms can get better as one ages
  • Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Keratosis Pilaris:

  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
  • The presence of dirt on the body is not a causative factor for Keratosis Pilaris. However, it helps to be clean and hygienic, which will help the condition from getting worse
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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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