Widespread Small Papular Eruption in Adolescent Male

Case at a Glance

A 14-year-old male presented with multiple small, flesh-colored papules distributed across his hands, arms, legs, and chest, with occasional mild pruritus and a tendency for the lesions to rupture without discharge.

Patient's Story

The patient reported the gradual appearance of numerous small bumps on his extremities and trunk over several months. He described the lesions as occasionally itchy but generally asymptomatic. The patient noted that some bumps would spontaneously rupture or could be manually expressed, similar to comedones, but without any visible discharge or fluid. The condition caused mild cosmetic concern but no significant discomfort.

Initial Assessment

Physical examination revealed multiple small, dome-shaped, flesh-colored to slightly hyperpigmented papules measuring 1-2mm in diameter. The lesions were distributed symmetrically on the dorsal surfaces of hands, forearms, lower legs, and scattered across the chest. No signs of inflammation, scaling, or secondary infection were observed. The papules had a smooth surface with some showing central puncta.

The Diagnostic Journey

The clinical presentation and distribution pattern suggested several differential diagnoses including keratosis pilaris, molluscum contagiosum, or follicular keratosis. The lack of discharge upon rupture and the characteristic appearance helped narrow the diagnostic possibilities. A detailed family history was obtained to assess for any hereditary skin conditions.

Final Diagnosis

Keratosis pilaris - a common benign condition characterized by follicular hyperkeratosis resulting in small, rough papules typically found on extensor surfaces of extremities and sometimes trunk.

Treatment Plan

Patient education regarding the benign nature of the condition was provided. Topical treatment recommendations included regular use of moisturizers containing urea or lactic acid, and gentle exfoliation with a soft washcloth. Topical retinoids were discussed as a potential option if symptoms persisted or worsened.

Outcome and Follow-up

The patient was advised that keratosis pilaris often improves with age and proper skin care. Follow-up was scheduled in 3 months to assess response to topical therapy and provide additional treatment options if needed. Parents were counseled about the chronic but benign nature of the condition.