- A diagnosis of non-inflammatory keratosis pilaris is
- Recommendation: mechanical exfoliation with washcloth daily in
the shower, followed by daily application of 20% urea cream
- Gentle skin care reviewed and educational handout provided to
Follow-up evaluation strategy
Further to the case in question, general evaluation and
treatment for keratosis pilaris is provided below.
After the keratinous plugs have been removed, use of an
emollient cream containing 20% urea (Carmol) may prevent
reappearance of lesions. Use of the abrasive scrub pad should be
resumed at the first sign of reappearance of crops of new lesions.
Patient education on gentle skin care, including discussion of
bathing, mild soaps, and lubrication also should be taught;
keratosis pilaris is almost invariably associated with xerosis, and
xerosis may, in fact, predispose to exacerbations of keratosis
Keratosis pilaris is an extremely common, often autosomal
dominantly inherited disorder that usually does not require
treatment and 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 keratosis pilaris on the
buttocks and thighs.
Folliculitis may present as development of increased erythema or
pustules in the affected area. Since keratosis pilaris 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.
Keratosis pilaris may be seen in association with other
cutaneous features suggestive of a genetic syndrome with either
cutaneous-only or systemic involvement (such as
cardiofaciocutaneous syndrome). Keratosis pilaris rubra is a
relatively common variant of keratosis pilaris with highly
inflammatory keratosis pilaris lesions that primarily involves the
cheeks, sometimes with extension of lesions onto the forehead and
chin. A rarer variant is keratosis pilaris atrophicans faciei, a
form that presents in infancy and is marked by atrophic lesions of
the lateral eyebrows, sometimes with scarring alopecia. The latter
variant is notable because it may present as an idiopathic form or
in association with genetic syndromes, such as Noonan syndrome,
Cornelia de Lange, syndrome Rubenstein-Taybi syndrome, as well as
Alcantara Gonzalez J, et al. Keratosis pilaris rubra and
keratosis pilaris atrophicans faciei treated with pulsed dye laser:
report of 10 cases. JEADV 2010;25:710-4.
Breithaupt AD, et al. A comparative trial comparing the efficacy
of tacrolimus 0.1% ointment with Aquaphor ointment for the
treatment of keratosis pilaris. Ped Derm 2011;28(4):459-77.
Clark SM, et al. Treatment of keratosis pilaris atrophicans with
the pulsed tunable dye laser. J Cutan Laser Ther 2000;2:151-6.
Kaune KM, et al. Successful treatment of severe keratosis
pilaris rubra with a 595-nm pulsed dye laser. Derm Surg
Marqueling A, et al. Keratosis pilaris rubra: a common but
underrecognized condition. Arch Derm 2006;142:1611-6.