Keratosis Pilaris Rubra Faciei: Assessing the Unmet Therapeutic Need

Keratosis pilaris rubra faciei (KPRF) is a clinical variant of keratosis pilaris characterized by prominent facial erythema and follicular papules that can cause significant aesthetic concern. The condition is underrecognized, frequently self-diagnosed, and lacks established evidence-based treatment guidelines.

To characterize the demographics, diagnostic pathways, treatment experiences, and psychosocial impact among individuals with KPRF and to explore perceived responses to commonly used therapies, including topical sirolimus.

A 24-item survey was distributed to members of a Reddit-based KPRF support group. Survey domains included demographics, diagnostic history, symptom triggers, treatments trialed, and mental health impact. Descriptive statistics were calculated using RStudio.

Seventy-nine respondents completed the survey. Most were men (73.4%) aged 18 to 30 years (70.9%) and resided outside the United States (69.6%). Symptom onset typically occurred before age 18, though diagnosis was frequently delayed; 38% reported self-diagnosis with social media input. The face was the most affected site (98.7%). Nearly all participants (98.7%) reported a negative impact on mental health. Common treatments included pulsed dye laser, topical keratolytics, retinoids, and topical sirolimus. Among participants who used compounded topical sirolimus, 75% reported improvement during treatment.

The primary limitations of this study include the relatively small sample size and potential response bias inherent in self-reported survey data.

KPRF is associated with delayed diagnosis, frequent reliance on social media for information, and substantial psychosocial burden. Self-reported improvement with topical sirolimus highlights the need for controlled studies and greater clinical awareness of this underrecognized condition.