In a previous study it was found that young patients with insulin-dependent diabetes mellitus had a higher prevalence of KP than healthy controls, with a high correlation with body mass index (BMI) and ichthyosiform skin changes of the legs.Ĭurrently available treatment modalities for KP include various keratolytics, vitamin D3 analogs, topical systemic retinoids and various laser therapies. It has also been suggested that insulin resistance may play a role in the development of keratosis pilaris. Hyperandrogenism has been known to cause hyperkeratinization of the pilosebaceous unit of terminal hairs in response to circulating androgens probably leading to increased incidence of KP in the pubertal age group. More than 22 mutations have been described till date. It is proposed to be a disorder of the keratinocytes caused by a mutation in the FLG gene which codes for fillagrin that is responsible for inducing both hyperkeratosis and inflammatory changes. Yet, much is still unknown about the sequence of biologic, physicochemical, and aberrant regulatory events leading to the clinical manifestations of KP. The recent identification of ‘loss-of-function’ mutations in the structural protein filaggrin as a widely replicated major risk factor for atopic eczema and associated conditions e.g., ichthyosis vulgaris and keratosis pilaris, suggests that the primary pathogenetic mechanism in KP is an epithelial barrier abnormality. There are no previous studies evaluating the dermoscopic features of KP. Keratosis pilaris is believed to be a disorder of keratinization and there is very limited literature describing its etiopathogenesis. It was noted that perifollicular erythema was more prominent in these cases. Three of the female patients had undergone waxing for hair removal prior to the dermoscopic evaluation but coiled hair could be visualized embedded in the superficial epidermis even in these cases. Perifollicular scaling was seen in 9 patients. Perifollicular erythema was seen in 11 patients. Even after the coiled hair shaft, embedded in the uppermost epidermis was dislodged from it with the help of a needle, it continued to maintain its coiled nature. The hair shaft formed a semicircle in 3 patients and a loop in 5 patients. In larger lesions, a coiled hair shaft was visualized emerging from the infundibulum. None of the small lesions had perifollicular erythema or perifollicular scaling. Six patients were found to have small papules of keratosis pilaris 19 had larger lesions.ĭermoscopic examination with white light revealed that all the small papules of KP had a coiled or semicircular intermediate hair embedded superficially in the epidermis. All the 25 patients were found to have circular, twisted or coiled hair shafts within the affected follicular infundibula which could be extracted using a 26G needle. One other patient had concomitant follicular eczema. Nine patients had concomitant ichthyosis vulgaris. Of the 25 patients included in the study, 16 patients had history suggestive of atopy. The age of the patients who underwent dermoscopic examination ranged from 6-38 years with average age of 18 years.
We correlated the findings with the clinical features in these cases to further our understanding of the disease. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris. The most accepted theory proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. The pathogenesis of KP is still not well understood. These include phrynoderma, follicular eczema, follicular lichen planus, juvenile pityriasis rubra pilaris, acne vulgaris, acneiform drug eruption, trichostasis spinulosa, ichthyosis follicularis, scurvy, eruptive vellus hair cysts and perforating folliculitis. Conditions presenting as keratotic follicular papules may be considered in the differential diagnosis of KP. Known associations of KP include atopy (55%), ichthyosis vulgaris, scarring alopecia, cardio–fascio–cutaneous syndrome, ectodermal dysplasia, KID syndrome, obesity, prolidase deficiency and Down's syndrome. Keratosis pilaris: Keratotic follicular papules present on the extensor aspect of both forearms
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