EpistemisKeratosis pilaris
Specialty: Skin.
Why it occurs
- Anomaly of follicular keratinization characterized by the formation of dense keratin plugs at the mouth of the hair follicles (frequently associated with a personal history of atopic dermatitis or ichthyosis vulgaris)
- Genetic factors of autosomal dominant inheritance
- Cold and low humidity environments that worsen xerosis and blockage
- Hormonal alterations of puberty (frequent onset or worsening at this stage of life)
- Mutations in the filaggrin gene that alter cellular hydration.
Initial workup
Clinical diagnosis by visualization and tactile inspection of rough, painless, keratotic follicular papules on the posterolateral aspects of the arms, thighs, or cheeks. It does not require laboratory tests or routine biopsy due to its pathognomonic benignity.
red flags
Presence of severe generalized follicular erythema associated with pain to the touch, progressive follicular atrophy with definitive hair loss in areas of the eyebrows or scalp (keratosis pilaris decalvans or oophryogens with permanent aesthetic risk).
Standard management
- 2% or 3% salicylic acid in emollient cream — topical keratolytic that dissolves the keratin plug in the follicle
- 10% or 20% urea in lotion — gentle rehydrating and keratolytic agent to soften rough skin
- 12% lactic acid cream — alpha-hydroxy acid that promotes the exfoliation of the outer keratinized layers
- 0.025% tretinoin cream or 0.05% Tazarotene cream (indicated in severe cases or with a large follicular erythematous component to normalize local cell differentiation).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4