- Megan N Landis, MD
Megan N Landis, MD
- Assistant Clinical Professor of Dermatology
- University of Louisville School of Medicine
Keratosis pilaris (KP) is a common disorder of follicular keratinization characterized by keratotic follicular papules with variable perifollicular erythema. Lesions involve predominantly the extensor aspects of proximal arms, thighs, and cheeks (picture 1A-C). KP is often seen in association with atopic dermatitis and ichthyosis vulgaris .
Onset of KP typically occurs in children or adolescents without sex predilection. It is seen in all ethnic groups, with an estimated prevalence of 2 to 12 percent in pediatric populations [2-4].
ETIOLOGY AND PATHOGENESIS
The cause of KP is not fully understood. It is thought to be a genetic disorder of keratinization that results in the formation of horny plugs in the hair follicle orifices. The mode of inheritance has not been determined, although in many cases it fits into an autosomal dominant pattern with incomplete penetrance. Patients with a generalized form of KP have been found to have a chromosome 18p deletion [5,6]. There are a few reports of KP induced by nilotinib, a second-generation tyrosine kinase inhibitor approved for the treatment of imatinib-resistant chronic myeloid leukemia [7-9].
An orthokeratotic keratin plug, which may contain one or more twisted hairs, fills and dilates the infundibulum of the hair follicle and protrudes above the skin surface (picture 2). There may be a mild perivascular lymphocytic infiltrate in the upper dermis .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis 2008; 82:177.
- Del Pozzo-Magaña BR, Lazo-Langner A, Gutiérrez-Castrellón P, Ruiz-Maldonado R. Common Dermatoses in Children Referred to a Specialized Pediatric Dermatology Service in Mexico: A Comparative Study between Two Decades. ISRN Dermatol 2012; 2012:351603.
- Popescu R, Popescu CM, Williams HC, Forsea D. The prevalence of skin conditions in Romanian school children. Br J Dermatol 1999; 140:891.
- Inanir I, Sahin MT, Gündüz K, et al. Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors. Pediatr Dermatol 2002; 19:307.
- Nazarenko SA, Ostroverkhova NV, Vasiljeva EO, et al. Keratosis pilaris and ulerythema ophryogenes associated with an 18p deletion caused by a Y/18 translocation. Am J Med Genet 1999; 85:179.
- Zouboulis CC, Stratakis CA, Gollnick HP, Orfanos CE. Keratosis pilaris/ulerythema ophryogenes and 18p deletion: is it possible that the LAMA1 gene is involved? J Med Genet 2001; 38:127.
- Leong WM, Aw CW. Nilotinib-Induced Keratosis Pilaris. Case Rep Dermatol 2016; 8:91.
- Shimizu A, Hattori M, Takeuchi Y, Ishikawa O. Generalized keratosis pilaris-like eruptions in a chronic myelogenous leukemia patient treated with nilotinib. J Dermatol 2016; 43:1100.
- Tawil MH, El Khoury R, Tomb R, Ghosn M. Nilotinib-induced Keratosis Pilaris Associated with Alopecia Areata and Eyebrow Thinning. Int J Trichology 2017; 9:87.
- Weedon D. Weedon's Skin Pathology, 3rd ed, Churchill Livingstone, Edinburgh 2010.
- Castela E, Chiaverini C, Boralevi F, et al. Papular, profuse, and precocious keratosis pilaris. Pediatr Dermatol 2012; 29:285.
- Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol 1994; 130:711.
- Jackson JB, Touma SC, Norton AB. Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy? W V Med J 2004; 100:26.
- Marqueling AL, Gilliam AE, Prendiville J, et al. Keratosis pilaris rubra: a common but underrecognized condition. Arch Dermatol 2006; 142:1611.
- Sardana K, Relhan V, Garg V, Khurana N. An observational analysis of erythromelanosis follicularis faciei et colli. Clin Exp Dermatol 2008; 33:333.
- Augustine M, Jayaseelan E. Erythromelanosis follicularis faciei et colli: relationship with keratosis pilaris. Indian J Dermatol Venereol Leprol 2008; 74:47.
- Mevorah B, Marazzi A, Frenk E. The prevalence of accentuated palmoplantar markings and keratosis pilaris in atopic dermatitis, autosomal dominant ichthyosis and control dermatological patients. Br J Dermatol 1985; 112:679.
- Pavlović MD, Milenković T, Dinić M, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care 2007; 30:1964.
- Boza JC, Trindade EN, Peruzzo J, et al. Skin manifestations of obesity: a comparative study. J Eur Acad Dermatol Venereol 2012; 26:1220.
- Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol 2007; 56:901.
- Bilgili SG, Akdeniz N, Karadag AS, et al. Mucocutaneous disorders in children with down syndrome: case-controlled study. Genet Couns 2011; 22:385.
- Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M. Mucocutaneous findings in 100 children with Down syndrome. Pediatr Dermatol 2007; 24:317.
- Friedman SJ. Lichen spinulosus. Clinicopathologic review of thirty-five cases. J Am Acad Dermatol 1990; 22:261.
- Maronn M, Allen DM, Esterly NB. Phrynoderma: a manifestation of vitamin A deficiency?... The rest of the story. Pediatr Dermatol 2005; 22:60.
- Disorders of hair and nails. In: Hurwitz Clinical Pediatric Dermatology, 4th ed, Paller AS, Mancini AJ (Eds), Elsevier Saunders, New York 2011.
- Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges 2006; 4:319.
- Garwood JD. Keratosis pilaris. Am Fam Physician 1978; 17:151.
- James WD, Berger T, Elston D. Andrews' diseases of the skin: Clinical dermatology, 11th ed, Saunders, London 2011.
- Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol 1984; 11:305.
- Bogle MA. Tazarotene 0.05% cream for the treatment of keratosis pilaris. J Am Acad Dermatol 2004; 50:P39.
- Gerbig AW. Treating keratosis pilaris. J Am Acad Dermatol 2002; 47:457.
- Lee SJ, Chung WS, Kim J, Cho SB. Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser and microdermabrasion treatment for keratosis pilaris. J Dermatol 2012; 39:479.
- Lee SJ, Choi MJ, Zheng Z, et al. Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients. J Cosmet Laser Ther 2013; 15:150.
- Saelim P, Pongprutthipan M, Pootongkam S, et al. Long-pulsed 1064-nm Nd:YAG laser significantly improves keratosis pilaris: a randomized, evaluator-blind study. J Dermatolog Treat 2013; 24:318.
- Ibrahim O, Khan M, Bolotin D, et al. Treatment of keratosis pilaris with 810-nm diode laser: a randomized clinical trial. JAMA Dermatol 2015; 151:187.