Troublesome rough skin

Presentation: For several years this young man had noticed his skin felt a bit 'rough', but as it had caused no symptoms apart from the occasional itching, he had ignored it.

In recent weeks it had become worse and his girlfriend was complaining about it and saying his skin felt like sandpaper.

On examination, the outer sides of his upper arms and thighs were affected and small keratin plugs could be seen centred on the hair follicles, typical of keratosis pilaris. Some showed slight inflammation.

Management

Keratosis pilaris is a common problem that affects up to 80% of adolescents. Although there is a tendency for it to improve with age, 40% of adults continue to have it. Severity may change with the seasons, tending to be worse in the winter, and it may be associated with ichthyosis or atopic dermatitis. It is a harmless, non-infectious skin condition. Many cases remain symptomless and may clear without treatment, but more severe cases may require therapy.

There is no specific cure, but it may improve with frequent application of moisturisers. Occasionally, these are combined with a short course (seven to 10 days) of a medium-potency topical steroid.

Salicylic acid or benzoyl peroxide, or washing with a gentle cleanser, may help, and once any inflammation has settled, rough bumps can be treated with 2-3% salicylic acid or 20% urea cream, or an exfoliator. For more persistent cases, laser hair removal, laser resurfacing or oral isotretinoin are occasionally tried.

Differential diagnosis

  • Acne vulgaris
  • Atopic dermatitis
  • Folliculitis
  • Darier's disease
  • Lichen nitidus
  • Milia
  • Pityriasis rubra pilaris
  • Xerosis

Dr Watkins is a retired GP in Hampshire

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