Keratosis pilaris is a disorder of keratinization in which horny plugs fill the openings of hair follicles.
Keratosis pilaris is common. The cause is unknown, but it is often associated with an autosomal dominant pattern of inheritance. It is associated with atopic dermatitis, seasonal allergic rhinitis, ichthyosis vulgaris, obesity, and diabetes mellitus type 1.
Clinical presentation is characterized by multiple small, pointed, keratotic (keratin-filled) follicular papules that appear mainly on the lateral aspects of the upper arms, thighs, and buttocks. Facial lesions may also occur, particularly in children. One such variant is keratosis pilaris rubra. Lesions are most prominent in cold weather and sometimes abate in the summer. Lesions may appear red.
The problem is mainly cosmetic, but the disorder may cause itching or, rarely, follicular pustules.
Treatment of Keratosis Pilaris
Symptomatic measures
Treatment of keratosis pilaris is usually unnecessary and can often be unsatisfactory because of the variable response to treatments.
Hydrophilic petrolatum and water (in equal parts) or petrolatum with 3% salicylic acid may help flatten the lesions. Buffered lactic acid (ammonium lactate) lotions or creams, urea creams, 6% salicylic acid gel, or 0.1% tretinoin cream or gel may also be effective (1). Other effective topical retinoids include adapalene 0.1% cream or gel and tazarotene 0.05% cream or gel. Topical tacrolimus and azelaic acid in various strengths have also been shown to be effective. Acid creams should be avoided in young children because of burning and stinging.
Pulse-dye and Q-switched Nd:YAG 1064 nm lasers have been used successfully to treat facial redness, especially in pediatric patients with keratosis pilaris rubra.
Treatment reference
1. Wang JF, Orlow SJ. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol. 2018;19(5):733-757. doi:10.1007/s40257-018-0368-3
