3. This patient presents with her cheeks quite red and covered with hyperkeratotic, rough, pinpoint papules. No other blemishes or lesions are seen on her face, but there are hundreds of hyperkeratotic papules on her bilateral triceps, giving a “chicken skin” appearance.
Diagnosis: Keratosis pilaris (KP) is an extremely common and harmless problem that affects up to 70% of newborns, though it may not fully express until age 1 or 2. Caused by an overproduction of perifollicular keratin, KP is inherited in an autosomal dominant pattern and is often seen in conjunction with atopic dermatitis and related conditions (eg, eczema, xerosis, asthma, icthyosis). KP can manifest anywhere on the body except glabrous skin (palms and soles).
Variants of KP are also common; the one affecting this patient is keratosis pilaris rubra facei. This condition is often confused with acne, but treating it as such worsens irritation—especially in the wintertime, when humidity levels are low.
For more information, see “Acne: Maybe She's Born With It?” Clinician Reviews. 2016 July;26(7):W1.