Definition
Keratosis pilaris (KP) is a common, benign follicular skin condition characterized by small, rough papules, often described as “chicken skin.” It results from keratin plugging of hair follicles, leading to follicular hyperkeratosis.
Epidemiology
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Affects up to 40–50% of the population.
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More common in children and adolescents; often improves with age.
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Slight female predominance.
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Frequently associated with atopic dermatitis and ichthyosis vulgaris.
Etiology and Pathophysiology
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Caused by overproduction and abnormal retention of keratin, which blocks the opening of hair follicles.
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The exact mechanism is not fully understood but is linked to:
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Genetic predisposition (autosomal dominant pattern in some cases).
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Dry skin (xerosis).
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Atopic tendency (eczema, allergic rhinitis, asthma).
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Risk Factors
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Family history of KP.
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Atopic dermatitis.
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Dry, cold climates.
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Obesity.
Clinical Presentation
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Lesions: Multiple small (1–2 mm), rough, flesh-colored or red papules.
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Distribution: Most commonly on the outer upper arms, thighs, buttocks, and sometimes cheeks.
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Texture: Sandpaper-like roughness.
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Usually asymptomatic, though mild itchiness or cosmetic concern may occur.
Diagnosis
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Clinical diagnosis based on history and examination.
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No need for biopsy unless diagnosis is uncertain.
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Differentials include: folliculitis, acne, pityrosporum folliculitis, lichen spinulosus.
Management
1. General Skin Care
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Daily moisturization to reduce dryness and scaling.
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Avoid hot showers and harsh soaps; use mild, non-soap cleansers.
2. Keratolytic Agents (help dissolve keratin plugs)
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Urea cream 10–40%: Apply once or twice daily.
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Lactic acid 12% lotion: Apply once or twice daily.
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Salicylic acid 2–6% cream/lotion: Apply once daily to affected areas.
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Ammonium lactate 12% lotion: Apply twice daily.
3. Topical Retinoids (normalize follicular keratinization)
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Tretinoin 0.025–0.05% cream: Apply once daily at night.
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Adapalene 0.1–0.3% gel: Apply nightly.
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Tazarotene 0.05–0.1% cream: Apply nightly (more potent, higher irritation risk).
4. Exfoliation
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Gentle mechanical exfoliation with a soft washcloth or loofah during bathing.
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Avoid aggressive scrubbing to prevent irritation.
5. Anti-inflammatory Measures (if redness/itching present)
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Short courses of low-potency topical corticosteroids (e.g., hydrocortisone 1% cream, applied twice daily for up to 7 days) in symptomatic flare-ups.
Prognosis
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Chronic but benign condition.
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Often improves with age and consistent skin care.
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Recurs if treatment is stopped, especially in dry seasons.
Patient Education
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Condition is harmless and not contagious.
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Treatment aims to improve appearance and texture, not cure.
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Consistency with moisturizers and keratolytics is key to maintaining results.
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