Beyond extensor surfaces: disseminated keratosis pilaris in childhood and its successful management with isotretinoin

Abstract

Keratosis pilaris (KP) is a common follicular keratinisation disorder typically limited to extensor surfaces. Disseminated involvement is rare. An 11-year-old girl presented with generalised hyperpigmented follicular keratotic papules involving the face, trunk, and extremities, sparing the palms and soles, associated with mild pruritus. There was no history of atopy, systemic illness, or nutritional deficiency. Histopathology showed orthokeratotic hyperkeratosis with follicular plugging and mild perifollicular inflammation, confirming KP. Dermoscopy revealed keratin plugs with coiled vellus hairs. Laboratory investigations, including serum retinol, were normal. The patient was treated with low-dose oral isotretinoin and topical keratolytics, resulting in marked clinical improvement within six weeks. Disseminated KP is an uncommon presentation, especially in children. Recognition of atypical hyperpigmented variants is important to avoid misdiagnosis. Systemic retinoids may be effective in extensive disease.