Synopsis
Recognise benign follicular keratin plugging, distinguish it from inflammatory, infective and nutritional mimics, explain its fluctuating natural history and offer proportionate moisturising or keratolytic care without promising cure.
- Keratosis pilaris produces many small rough follicular plugs, classically on the outer upper arms and thighs and sometimes cheeks or buttocks.
- Lesions are usually symmetrical and feel like permanent gooseflesh; colour may be skin-coloured, pink-red, violaceous or brown depending on inflammation and skin tone.
- It is common, benign, non-contagious and not caused by poor hygiene; no routine blood test, swab or biopsy is needed for a typical presentation.
Key red flags
Pain, pus, fever, rapid spread, blistering, scarring hair loss, nail or mucosal change, erythroderma, bleeding perifollicular lesions or dietary and systemic features suggesting nutritional deficiency requires diagnostic reassessment.
Bleeding gums, easy bruising, corkscrew hairs, severe dietary restriction or rapidly generalised hyperkeratosis requires urgent nutritional and medical assessment.
Investigation priorities
Confirm typical uniform follicular plugging and exclude pustular, comedonal or scarring disease.
Management branches
Uniform asymptomatic extensor follicular plugs occur without infection, scarring or systemic features.
- Name the condition, explain inherited follicular plugging and its non-contagious, medically harmless and fluctuating nature, and ask what outcome matters.
- Offer gentle cleansing, avoidance of picking and at least daily fragrance-free emollient after bathing, including clear fire-safety advice for contaminated fabrics.