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. 2012 Oct;4(4):255-8.
doi: 10.4103/0974-7753.111215.

Keratosis pilaris revisited: is it more than just a follicular keratosis?

Mary Thomas  1 , Uday Sharadchandra Khopkar
Affiliations

Keratosis pilaris revisited: is it more than just a follicular keratosis?

Mary Thomas et al. Int J Trichology. 2012 Oct.

Abstract

Background: Keratosis pilaris (KP) is characterized by keratinous plugs in the follicular orifices and varying degrees of perifollicular erythema. The most accepted theory of its pathogenesis proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris.

Materials and methods: Patients with a clinical diagnosis of KP seen between September 2011 and December 2011 were included in the study. A clinical history was obtained and examination and dermoscopic evaluation were performed on the lesions of KP.

Results: The age of the patients ranged from 6-38 years. Sixteen patients had history of atopy. Nine had concomitant ichthyosis vulgaris. All the 25 patients were found to have coiled hair shafts within the affected follicular infundibula. The hair shafts were extracted with the help of a sterile needle and were found to retain their coiled nature. Perifollicular erythema was seen in 11 patients; perifollicular scaling in 9.

Conclusion: Based on our observations and previously documented histological data of KP, we infer that KP may not be a disorder of keratinization, but caused by the circular hair shaft which ruptures the follicular epithelium leading to inflammation and abnormal follicular keratinization.

Keywords: Atopy; Keratosis Pilaris; coiled hair.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Keratosis pilaris: Keratotic follicular papules present on the extensor aspect of both forearms
Figure 2
Figure 2
Early KP lesion with a circular hair shaft emerging from a normal-appearing follicular opening
Figure 3
Figure 3
A looped hair shaft (a) and a coiled hair shaft (b) associated erythema and pigmentation. Note lack of keratin plug in (a)
Figure 4
Figure 4
The hair shaft retains its coiled nature even after being extracted from the superficial epidermis with a sterile needle
Figure 5
Figure 5
Perifollicular erythema and scaling surrounding a larger KP lesion
See this image and copyright information in PMC

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