By Gary M. White, MD
Keratosis pilaris is a very common condition in which the hair follicles become hyperkeratotic and variably inflamed. Some reports have shown an association with high body mass index, leg skin dryness, and an atopic diathesis. This condition of the follicular opening is quite common with young people being preferred. It has several features in common with follicular eczema. See also ulerythema ophryogenes for a rare condition that has some similar features.
The outer arms are typically rough to the touch. The dorsal thighs are often affected as well. Innumerable, small, white, keratotic plugs fill many of the follicular openings. Some lesions may appear to be pustules, but if opened, they are usually dry. Inflammation may also be present resulting in perifollicular erythema.
The condition tends to be chronic and may be worse when the skin dries out. Thus, emolliating the skin after the shower with a cream may help. Beyond this, most treatments are at best partially effective.
If the patient desires treatment, the following may be tried. If there is significant perifollicular erythema, a mid-potency topical steroid may be used, e.g., triamcinolone 0.1% cream or pimecrolimus cream. If follicular hyperkeratosis is the main finding, a keratolytic such as ammonium lactate 12% lotion or cream QD-BID or a lotion containing alpha hydroxy acid may be tried. A retinoid, e.g., adapalene 0.1% solution, could also be considered.
The cheeks of a child or teenager is a common location.
Perifollicular erythema is typical.
A mild case.
A very extensive case.
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