What is Keratosis Pilaris

Keratosis Pilaris: Overview and Management

Keratosis pilaris (KP) is a common, benign genetic skin disorder characterized by small, folliculocentric keratotic papules caused by keratin accumulation in hair follicles, typically affecting the extensor aspects of upper arms, thighs, and buttocks. 1

Clinical Characteristics

• Appearance: Small, rough bumps resembling "gooseflesh" or "plucked chicken skin" 2, 3
• Distribution: Primarily affects extensor surfaces of arms, upper legs, and buttocks 2
• Variants:
  • KP simplex (most common form)
  • Keratosis pilaris rubra (with more prominent erythema)
  • Erythromelanosis follicularis faciei et colli
  • Keratosis pilaris atrophicans (rare subtype) 1

Pathophysiology

• Results from hyperkeratinization of the follicular opening
• Associated with inherited mutations in the FLG gene and ABCA12 gene 1
• May be associated with ichthyosis vulgaris and palmar hyperlinearity 1
• Often worsens in dry, cold weather and improves in summer months

Differential Diagnosis

• Lichen spinulosus
• Phrynoderma
• Ichthyosis vulgaris
• Trichostasis spinulosa 1

Treatment Approach

First-Line Therapy: Topical Keratolytic Agents

1. Lactic acid - Most commonly used first-line therapy (43.63% of dermatologists) 4

2. Salicylic acid (6%) - Second most common first-line therapy (20.72% of dermatologists) 4

   • FDA-approved for hyperkeratotic skin disorders including keratosis pilaris 5
   • Apply once or twice daily to affected areas

3. Urea-containing preparations

   • FDA-approved for hyperkeratotic conditions including keratosis pilaris 6
   • Particularly useful for debridement and promotion of normal healing 6
   • Apply daily to affected areas after bathing

Second-Line Therapy

1. Topical retinoids

   • Apply nightly to affected areas
   • May cause irritation initially

2. Topical corticosteroids (for inflammatory variants)

   • Low to medium potency
   • Apply sparingly to reduce inflammation 2

General Skin Care Measures

• Avoid long hot baths or showers
• Use mild, non-soap cleansers
• Apply moisturizers immediately after bathing
• Consider using humidifiers in dry environments

Advanced Therapies for Refractory Cases

• Laser therapy - Used by only 8.76% of dermatologists due to lack of insurance coverage and equipment availability 4
• Microdermabrasion - For cases unresponsive to topical therapy 1

Treatment Challenges

• KP is often recalcitrant to treatment
• Over 60% of patients experience recurrence within three months of stopping treatment 4
• Continuous maintenance therapy is typically required

Patient Education

• KP is a chronic condition with no permanent cure
• Treatment aims to improve appearance rather than provide complete resolution
• Regular use of keratolytic agents and moisturizers is necessary for maintenance
• Condition may improve with age in some cases

Prognosis

• Benign condition with excellent prognosis
• May cause cosmetic concerns and occasional mild pruritus
• No impact on mortality or significant morbidity
• Often improves during summer months and with age

KP management requires consistent application of keratolytic agents combined with good skin hydration practices. While complete resolution is uncommon, significant improvement can be achieved with appropriate therapy and maintenance.