September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 21 year-old lady presented with a seven year history of a 'distressing' bumpy rash on her upper arms and thighs. The rash was asymptomatic. She had no other skin history and was otherwise well. Her mum had a similar problem.
The rash mainly affected her upper outer arms and thighs. There were large numbers of scaly, rough papules with varying degrees of perifollicular erythema.
What is the diagnosis?
The diagnosis is keratosis pilaris.
Keratosis pilaris (KP) is a very common skin condition characterised by keratinous plugging of hair follicles, with varying degree of perifollicular erythema, most commonly affecting the outer-upper arms and thighs.
KP is caused by abnormal keratinisation of the lining of the upper portion of the hair follicle, known as the follicular infundibulum - scale fills the follicle instead of exfoliating. Mild forms, appearing in childhood and adolescence, are extremely common and are best regarded as physiological 30-50% of cases have genetic origins, with an autosomal dominant inheritance.
KP is best described as a condition of childhood and adolescence, and although it often becomes more exaggerated at puberty, it frequently improves with age. However, some adults can have rather persistent KP.
Typical KP is symmetrical, most commonly affecting the outer-upper arms and thighs. It may also occur on the buttocks and cheeks, and less often on the forearms and upper back. The morphology is that of large numbers of scaly, rough papules, which in essence is the keratinous plugging of hair follicles. There is varying degrees of perifollicular erythema.
No cure is available for KP and treatment is rarely helpful. Female patients, in particular, may wish to try facial exfoliators with a buff for their arms and legs. Emollients containing urea (eg Calmurid ® cream, Balneum ® cream) or salicylic acid may be of some use in making the skin feel a little more smooth.
For more information please refer to the related chapter on keratosis pilaris.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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