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Keratosis Pilaris

 

Clinical Presentation

Keratosis pilaris is a common condition of children and young adults in which tiny follicular papules form. Keratosis pilaris consists of small clustered, firm, white papules approximately one millimeter in diameter. The papules are found in hair follicle distribution and are most often found on the lateral upper arms and anterior thighs. The buttocks is occasionally involved. The presence of keratosis pilaris causes the skin to have sandpaper like feeling. Occasionally, an inflammatory halo of lighter skin surrounds the white papules. The lesions of keratosis pilaris are located at follicular openings of hair follicles, and often can be scooped out with a fingernail or dermal curette. When this is done a coiled hair is sometimes found within the white semisolid material. The lesions are usually symptomless, though sometimes mild itching is present.

 

What Causes Keratosis Pilaris?

Keratosis pilaris tends to run in families. A father or mother may pass keratosis pilaris on to the children. Quite often, people with keratosis pilaris may also have asthma, hay fever, and/or allergies. In this setting, keratosis pilaris is a manifestation of a skin condition known as atopic dermatitis. Microscopically, keratosis pilaris is found to be a peculiar thickening and piling up of the tiny skin cells surrounding hair follicles. This thickening and piling up results in the little bumps you can see and feel.

Course and Prognosis

In keratosis pilaris, the individual papules may come and go over a matter of weeks. In general, the overall course is chronic and one cannot expect a complete cure. Keratosis pilaris may be controlled, but not cured.

 

Therapy

As keratosis pilaris may be controlled, but not cured, there is no good treatment for the cause of keratosis pilaris. Prolonged bathtub soaks, followed by mild scrubbing with a Buff Puff sponge may remove the plugs, but the lesions of keratosis pilaris may quickly reform. Lubricants and moisturizers, especially those with lactic acid or glycolic acid, may soften the dry skin, which accompanies keratosis pilaris. The application of peeling agents such as Retin-A or Tazorac can be tried, but the irritation they cause may be more troublesome than any mild benefit, which is obtained. Lactic acid, glycolic acid, and Retin-A may work to normalize the tiny cells around the hair follicles so that thickening and piling up does not occur. Cortisone medications may limit inflammation and thus help with symptoms.

 

ABC Bathing: It is important to avoid soap on areas of keratosis pilaris. Persons with keratosis pilaris involved skin may bathe or shower twice daily: 1. Use no soap on dry or sensitive skin areas. You may use mild Gentle Face and Body Cleanser, instead of soap. 2. After bathing, thoroughly lubricate your skin using Replenishing Cream available OTC. 3. After your bath, you should not towel dry. Wipe off the water with your hands, then, apply a thin film of True Moisture® Replenishing Cream to your entire body. This film will seal in your new moisture. 4. For shampoo, use OTC fragrance free Gentle Shampoo. Mild lubricants, or anti- pruritic creams, or mild hydrocortisone creams may be used all over the body to soothe the inflammation. Oral antihistamines may be used to reduce itching. Soap tends to dry the areas and increases roughness. Finally, picking or extracting of lesions are not recommended as picking may result in secondary infection with staph, strep, or other bacteria.

 

 

 

 

 

 
Ken Alpern, M.D. Charity Morris, PAC Eleni Litras,
PAC

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Hello, and welcome to our dermatology office. My name is Randy Jacobs, MD, FAAD. Some people are blessed with the most beautiful skin, and it’s all natural. Others have to work at it. Healthy skin is lovely to behold, comfortable to live in, and a pleasure to touch.
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