Clinical Challenge: Asymptomatic Dermatitis That Feels Like Sandpaper - MPR

Clinical Challenge: Asymptomatic Dermatitis That Feels Like Sandpaper

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A 29-year-old woman presents with a rash on her arm that the patient reports has been there “for as long as I can remember.” The dermatitis is asymptomatic, but the patient finds it annoying from a cosmetic standpoint. She states that her mother and sister both have a similarly distributed rash, but their rashes are not as prominent. Application of over-the-counter moisturizers and hydrocortisone cream has proven ineffective. Examination of both upper arms reveals multiple folliculocentric keratotic papules that feel like sandpaper. The patient’s thighs are similarly affected but to a lesser degree.

Keratosis pilaris is a benign disorder that results from follicular hyperkeratosis. It is seen in a significant percentage of adolescents and adults.1 Both sexes may be affected, but a preponderance among females has been noted.2 The condition is usually asymptomatic...

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Keratosis pilaris is a benign disorder that results from follicular hyperkeratosis. It is seen in a significant percentage of adolescents and adults.1 Both sexes may be affected, but a preponderance among females has been noted.2 The condition is usually asymptomatic and often found incidentally in patients during examination for another condition.3 Many cases have a genetic predisposition, and keratosis pilaris has been associated with atopic dermatitis.4


The condition commonly presents as folliculocentric keratotic papules imparting a rough texture to the skin. The papules are grouped along the extensor surfaces of the arms, legs, and buttocks. Patients will describe the skin as “chicken skin,” “chicken bumps,” or “goosebumps,” and they will typically have cosmetic concerns.3 When accompanied by erythema, the condition may be referred to as keratosis pilaris rubra.When the papules are gray-white without erythema, it may be referred to as keratosis pilaris alba.1

Keratosis pilaris tends to improve during the summer months and with advancing age. Moisturization of the affected areas is recommended, and topical preparations containing urea, salicylic acid, or alpha hydroxy acids may prove beneficial, although response to treatment is not consistent. Topical retinoids, such as tretinoin, adapalene, and tazarotene, can be used in those who fail to respond to the keratolytics.6 Treatment with lasers has afforded variable results.7

Megha D. Patel is a student at the Commonwealth Medical College, Scranton, PA.

Stephen SchleicherMD, is an associate professor of medicine at the Commonwealth Medical College and an adjunct assistant professor of dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, PA.

References

  1. Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. 1994;130(6):711-713.
  2. Hwang S, Schwartz RA. Keratosis pilaris: A common follicular hyperkeratosis. Cutis. 2008;82(3):177-180.
  3. Alai AN. Keratosis pilaris. Medscape Web site. Updated June 19, 2014. Available at emedicine.medscape.com/article/1070651-overview
  4. Mevorah B, Marazzi A, Frenk E. The prevalence of accentuated palmoplantar markings and keratosis pilaris in atopic dermatitis, autosomal dominant ichthyosis, and control dermatological patients. Br J Dermatol. 1985;112(6):679-685.
  5. Marqueling AL, Gilliam AE, Prendiville J, et al. Keratosis pilaris rubra: A common but underrecognized condition. Arch Dermatol.2006;142(12):1611-1616.
  6. Bogle MA, Ali A, Bartel H. Tazarotene 0.05% cream for treatment of keratosis pilaris. J Am Acad Dermatol.2004;50(3 Suppl):P39.
  7. Ibrahim O, Khan M, Bolotin D, et al. Treatment of keratosis pilaris with 810-nm diode laser: A randomized clinical trial. JAMA Dermatol.2015;151(2):187-191.