DERMATOLOGY

skin bumps

Keratosis pilaris

  • most often seen on the arms and legs but might also occur on the face, buttocks, or torso
  • patches of skin that appear bumpy, slightly red, and feel rough
  • may get worse in dry weathe
  • Prevalence:
    • Common in children and young adults.
    • 50-70% of teenagers and 40% of adults affected.
    • Associated with atopic eczema and ichthyosis.
  • Causes:
    • Abnormal keratinization in hair follicles.
    • Genetic link, possibly autosomal dominant.
    • Mutations in filaggrin gene implicated.
    • Worsens in dry, winter conditions.
  • Clinical Features:
    • ‘Goosebump’ or ‘chicken skin’ appearance.
    • Bumps can be skin-colored, red, or brown.
    • Rough, dry skin, occasionally itchy.
    • Commonly on upper arms, thighs, buttocks, trunk, chest, face.
    • Variants: erythromelanosis follicularis, ulerythema ophryogenes, atrophoderma vermiculatum.
  • Skin Type Variation:
    • Bumps match patient’s skin color.
    • Red on white skin; brown/black on darker skin.
  • Complications:
    • Atrophy.
    • Scarring and hair loss.
  • Diagnosis:
    • Clinical evaluation, dermoscopy, punch biopsy.
  • Differential Diagnosis:
    • Atopic dermatitis, folliculitis, milia, lichen nitidus, lichen spinulosus, phrynoderma.
  • Treatment:
    • Exfoliating techniques.
    • Moisturizers with urea, salicylic acid, lactic acid, alpha hydroxy acids.
    • Topical retinoids, short courses of topical steroids for itch.
    • Pulse dye laser, intense pulsed light for erythema, laser hair removal for ingrown hairs.
  • Outcome:
    • No cure but often improves in adulthood.
    • Management improves condition; atrophy or scarring may be permanent.

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