Adnexal and other

Question 1

Lichen spinulosus

Answer 1

• rare condition
• cause unknown - some feel is variant of KP
• Clinical: follicualr papules 2-3 mm in diameter, raised with pointed keratotic spine –> coalesce together ad form plaques

Question 2

Associated conditions of KP

Answer 2

• Ichthyosis vulgaris
• Atopic Eczema
• HS
• Obesity
• Medications: steroids, lithium, BRAF positive inhibitors

Question 3

Pathophysiology of KP

Answer 3

• excess keratin is formed that impedes the hair from emerging
• Can be autosomal dominant with variable penetrance

Question 4

Histology of KP

Answer 4

Hyperkeratosis, hypergranulosis and plugging of hair follicles

Question 5

Variants of KP

Answer 5

Erythromelansosi follicularis faciei et colli
KP Atrophicans faciei - or keratotsis rubra pilaris faciei atrophicans
Keratosis follicularis spinosa decalvans
Atrophoderma vermiculatum

Question 6

Erythromelansosi follicularis faciei et colli

Answer 6

More common in males in Middle East

Follicular hyperkeratosis with erythema and hyperpigmentation affecting lateral cheeks and neck

Question 7

KP Atrophicans faciei - or keratotsis rubra pilaris faciei atrophicans

Answer 7

Fixed bilateral cheek erythema wiht loss of lateral eyebrows, follicular scarring and pitting scarring, and hair loss

Question 8

Keratosis follicularis spinosa decalvans

Answer 8

cheek and nose resulting in follicular atrophy, can include scarring alopecia to the scalp
+/- palmoplantar hyperkeratosis

Question 9

Atrophoderma vermiculatum

Answer 9

Follicular plugging evolves towards reticulated atrophy of the skin
Cheeks and pre-auricular skin

Question 10

Differentials of KP

Answer 10

• Darier
• PRP
• Atopic eczema
• Lichen nitidus
• Lichen spinulosus
• Eruptive vellous hair cysts
• Acne
• Folliculitis
• Rosacea

Question 11

Treatment of KP

Answer 11

• 1: keratolytics particularly salicylic acid, lactic and glycolic acid
• 2: topical tertinoids
• 3: systemic retinoids
• 4: pulsed dye laser