What is the diagnosis for a 16-year-old girl presenting with numerous tiny, uniform, flesh-colored or slightly erythematous (red) papules on the posterior surface of her upper arms, associated with mild pruritus (itching) during winter months, and characterized by a rough, follicularly-based texture, often described as 'chicken skin' or sandpaper-like?

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Differential Diagnosis for the 16-year-old girl with a skin condition

  • Single most likely diagnosis
    • Keratosis Pilaris: This condition is characterized by the presence of small, uniform, flesh-colored or slightly erythematous papules that are follicularly based and have a rough, sandpaper-like texture. The symptoms and clinical findings match the description provided, and it is a common condition in adolescents.
  • Other Likely diagnoses
    • Follicular eczema: This condition could present with similar symptoms, including pruritus and follicular-based lesions. However, the lack of other eczematous features and the specific description of the lesions make Keratosis Pilaris more likely.
    • Pityriasis rubra pilaris: This is a rare condition, but it can present with follicular hyperkeratosis and erythematous papules. However, it typically has a more widespread distribution and is associated with other systemic symptoms.
  • Do Not Miss diagnoses
    • Phrynoderma: Although rare, this condition can present with similar follicular hyperkeratosis and is associated with nutritional deficiencies, particularly vitamin A and essential fatty acid deficiencies. Missing this diagnosis could lead to untreated underlying nutritional deficiencies.
    • Lichen spinulosus: This is a rare condition that can present with spiny, follicular lesions. Although it is unlikely, it is essential to consider it to rule out any potential underlying conditions that may require specific treatment.
  • Rare diagnoses
    • Ichthyosis vulgaris: This is a genetic condition that affects the skin's ability to shed dead skin cells, leading to dry, scaly skin. Although it can present with follicular hyperkeratosis, it is typically associated with a more widespread distribution and other systemic symptoms.
    • Erythromelanosis follicularis faciei et colli: This is a rare condition that presents with erythematous, follicular papules on the face and neck. Although it is unlikely given the location of the lesions, it is essential to consider it in the differential diagnosis to rule out any potential underlying conditions.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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