Keratosis pilaris — Rapid | Doctor’s Passport

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.
The condition often worsens with dry winter skin and may improve with age, but treatment controls texture rather than removing the inherited tendency permanently.
A fragrance-free emollient applied at least daily, especially after bathing, is the lowest-risk first step for dryness and roughness.
Urea, lactic acid or salicylic-acid products can soften plugs, but introduce one product gradually and stop if burning or dermatitis develops.
Avoid picking, abrasive scrubs and aggressive loofahs because trauma increases inflammation, hyperpigmentation and occasional scarring.
All paraffin-containing and paraffin-free emollient residue on clothing and bedding can increase fire intensity; keep away from flames, cigarettes and naked heat and wash fabrics regularly.

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.

Atypical systemic pattern

Bleeding gums, easy bruising, corkscrew hairs, severe dietary restriction or rapidly generalised hyperkeratosis requires urgent nutritional and medical assessment.

Investigation priorities

Clinical morphology and distribution examinationFirst step

Confirm typical uniform follicular plugging and exclude pustular, comedonal or scarring disease.

Management branches

Typical benign diseaseExplain and offer no-treatment choice

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.
Review only if desired or if morphology changes; no routine laboratory test, antibiotic or specialist referral is necessary.

Key medicines

Urea 10% creamApply a thin layer once or twice daily to rough affected body skin according to the selected product, beginning once daily on a small area.Can sting inflamed, fissured or freshly shaved skin; avoid eyes and mucosa, stop for dermatitis and use age-, pregnancy- and product-specific instructions.

Adapalene 0.1% gelApply a very thin film once daily in the evening to a limited affected area only when an experienced prescriber agrees an off-label trial, introducing it less often if sensitive.Contraindicated in pregnancy and pregnancy planning; avoid eczema, broken skin and excessive ultraviolet exposure, moisturise and stop if irritancy outweighs a cosmetic benefit.

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