Which physical findings are characteristic of pediatric keratosis pilaris?

Updated: May 27, 2021
  • Author: Derek H Chu, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Physical examination findings consist of ill-defined groups of small, skin-colored, keratotic, follicular papules, with (keratosis pilaris rubra) or without (keratosis pilaris alba) significant inflammation or perifollicular erythema, as shown below. Keratosis pilaris rubra tends to be more widespread than typical keratosis pilaris. [13]

 

Keratosis pilaris occurs most commonly on the late Keratosis pilaris occurs most commonly on the lateral upper arms and upper thighs.

 

The lesions of keratosis pilaris are evenly spaced The lesions of keratosis pilaris are evenly spaced, consistent with the follicular origin of this disorder.

 

Close examination of keratosis pilaris shows kerat Close examination of keratosis pilaris shows keratotic papules associated with hair follicles. Keratinocytes at the follicular orifice are retained, producing keratin plugs.

Occasionally, patients may develop acneiform pustules or cysts, as shown below. A fine hair may pierce the papules, or hair may be found coiled up within the keratin plug. The keratin plug usually cannot be expressed with pressure.

Bacteria associated with the follicular papules of Bacteria associated with the follicular papules of keratosis pilaris may cause some lesions to become erythematous or pustular.

The papules are predominantly located over the posterolateral upper arms and anterior thighs, though they can also involve the face, buttocks, and trunk less commonly. They tend to be monomorphic and evenly spaced.

A pronounced, widespread variant has been described in infants—papular, profuse, and precocious keratosis pilaris. [14]


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