Keratosis pilaris

Keratosis pilaris: This harmless skin condition causes tiny, rough-feeling bumps on the skin.

What is keratosis pilaris?

Keratosis pilaris is a common skin condition, which appears as tiny bumps on the skin. Some people say these bumps make their skin look like plucked chicken skin. Others mistake the bumps for small pimples.

These rough-feeling bumps are actually plugs of dead skin cells. The plugs appear most often on the upper arms and thighs (front). Children may have these bumps on their cheeks.

If the itch, dryness, or the appearance of keratosis pilaris bothers you, treatment can help.Dry skin can make these bumps more noticeable. In fact, many people say the bumps clear during the summer only to return in the winter. If you live in a dry climate or frequently swim in a pool, you may see these bumps year round.

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References:
Schmitt JV, Lima BZ. “Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study.” An Bras Dermatol. 2014 Jan-Feb; 89(1):91–5.

Keratosis pilaris: The rough-feeling bumps can appear in many colors, including skin colored and white.

Keratosis pilaris: Signs and symptoms

This common skin condition causes tiny bumps that can:

• Feel rough and dry like sandpaper
• Resemble the skin of a plucked chicken
• Become more noticeable in winter or a dry climate
• Itch
• Appear in different colors, including the same color as your skin, white, red, pinkish purple (on fair skin), and brownish black (on dark skin) 

Some people have a few flesh-colored bumps. Others have noticeable bumps that look like pimples or a rash.

Where keratosis pilaris appears

These bumps can appear anywhere on your skin, except on your palms and soles. Bumps on the arms are common. Most people will see these bumps appear in the following areas:

Children: Upper arms, thighs (front), and cheeks

Teens and adults: Upper arms, thighs (front), and buttocks

Some people develop so many bumps on their skin that the bumps extend to their lower legs and forearms.

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References:
Alai AN. “Keratosis pilaris clinical presentations.” Medscape. Last updated June 19, 2014.
Park J, Kim BJ, et. al. “A pilot study of Q-switched 1064-nm Nd:YAG laser treatment in the keratosis pilaris.” Ann Dermatol. Aug 2011; 23(3): 293–298.
Thomas M, Khopkar US. “Keratosis pilaris revisited: Is it more than just a follicular keratosis?” Int J Trichology. 2012 Oct;4(4):255-8.
Yang G, Bordeaux J, et. al. “Prospective right/left comparison of azeleic acid and cetaphil for treatment of keratosis pilaris.” J Am Acad Dermatol. 2012 Apr;66(4) Supp. 1: AB167.
Zhu JW, Lu ZF, et. al. “Unilateral generalized keratosis pilaris following pregnancy.” Cutis. 2014 Oct;94(4):203-5.

Keratosis pilaris: Who gets and causes

Child with keratosis pilaris: This skin condition often appears before 2 years of age.

Who gets keratosis pilaris?

People of all ages and races have this common skin condition. For most people, it begins at one of the following times:

• Before 2 years of age
• During the teenage years

Because keratosis pilaris usually begins early in life, children and teenagers are most likely to have this skin condition. Fewer adults have it because keratosis pilaris can fade and gradually disappear.

The bumps may clear by the time a child reaches late childhood or adolescence. Hormones, however, may cause another flare-up around puberty. When keratosis pilaris develops in the teenage years, it often clears by one’s mid-twenties.

Keratosis pilaris can also continue into one’s adult years. Women are a bit more likely to have keratosis pilaris.

What increases a person’s risk of getting keratosis pilaris?

You are more likely to develop it if you have one or more of the following:

• Close blood relatives who have keratosis pilaris
• Asthma
• Dry skin
• Eczema (atopic dermatitis)
• Excess body weight, which makes you overweight or obese
• Hay fever
• Ichthyosis vulgaris (a skin condition)
• Melanoma and are taking vemurafenib (Zelboraf®), a targeted therapy medicine approved to treat melanoma that has spread

When treating melanoma with vemurafenib

If you develop small, rough bumps while taking vemurafenib, you’ll likely see them within the first 8 weeks of starting the drug. The bumps may worsen as your dose increases; however, the skin tends to clear completely when you stop taking vemurafenib.

If the bumps on your skin bother you, applying one of the following can help while you are taking vemurafenib:

• Ammonium lactate cream or lotion (12%): Apply it as directed by your dermatologist.
• A moisturizer: A cream or ointment works best. Apply it after bathing and gently massage it into the skin with keratosis pilaris 2 or 3 times a day.

What causes keratosis pilaris?

Keratosis pilaris is not contagious. We get keratosis pilaris when dead skin cells clog our pores.

A pore is also called a hair follicle. Every hair on our body grows out of a hair follicle, so we have thousands of hair follicles. When dead skin cells clog many hair follicles, you feel the rough, dry patches of keratosis pilaris.

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References:
Boyd KP, Vincent B, et. al. “Nonmalignant cutaneous findings associated with vemurafenib use in patients with metastatic melanoma.” J Am Acad Dermatol, 2012 Dec;67(6):1375–79.
Boza JC, Trindade EN, et. al. “Skin manifestations of obesity: a comparative study.” J Eur Acad Dermatol Venereol. 2012 Oct;26(10):1220-3.
Castela E, Chiaverini C, et. al. “Papular, profuse, and precocious keratosis pilaris.” Pediatr Dermatol. 2012 May-Jun;29(3):285-8.
Peters S, Bouchaab H, et. al. “Dramatic response of vemurafenib-induced cutaneous lesions upon switch to dual BRAF/MEK inhibition in a metastatic melanoma patient.” Melanoma Res. 2014 Oct;24(5):496-500.
Rinderknecht JD, Goldinger SM. “RASopathic skin eruptions during vemurafenib therapy.” PLoS One. 2013; 8(3): e58721. Published online Mar 14, 2013.
Schmitt JV, Lima BZ. “Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study.” An Bras Dermatol. 2014 Jan-Feb;89(1):91–5.
Thomas M, Khopkar US. “Keratosis pilaris revisited: Is it more than just a follicular keratosis?” Int J Trichology. 2012 Oct;4(4):255-8.
Yosipovitch G, DeVore A, et. al. “Obesity and the skin: Skin physiology and skin manifestations of obesity.” J Am Acad Dermatol. 2007 Jun;56(6):901–16.

Keratosis pilaris: Diagnosis and treatment

How do dermatologists diagnose keratosis pilaris?

To diagnose this condition, your dermatologist will examine your skin — looking closely at the skin that shows signs of keratosis pilaris.

How do dermatologists treat keratosis pilaris?

This skin condition is harmless, so you don’t need to treat it.

If the itch, dryness, or the appearance of your skin bothers you, treatment can help. A dermatologist can create a treatment plan that addresses your concerns. The following describes what a treatment plan may include:

Relieve the itch and dryness: A creamy moisturizer can soothe the itch and dryness. Most moisturizing creams used to treat keratosis pilaris contain one of the following ingredients:

• Urea
• Lactic acid

For best results, apply your moisturizer: After every shower or bath Within 5 minutes of getting out of the bath or shower, while your skin is still damp At least 2 or 3 times a day, gently massaging it into the skin with keratosis pilaris

Diminish the bumpy appearance: To diminish the bumps and improve your skin’s texture, dermatologists often recommend exfoliating (removing dead skin cells from the surface of your skin). Your dermatologist may recommend that you gently remove dead skin with a loofah or at-home microdermabrasion kit.

Your dermatologist may also prescribe a medicine that will remove dead skin cells. Medicine that can help often contains one of the following ingredients:

• Alpha hydroxyl acid
• Glycolic acid
• Lactic acid
• A retinoid (adapalene, retinol, tazarotene, tretinoin)
• Salicylic acid
• Urea

For best results when using a medicine to exfoliate your skin: Use the amount your dermatologist recommends. Apply it only as often as your dermatologist recommends. Stop using the medicine for a few days if your skin becomes dry or irritated.

The medicine you use to exfoliate your skin may also contain a moisturizer, which can help with the itch and dryness.

To treat the bumps, some patients may need to apply a corticosteroid to the areas with keratosis pilaris. This medicine helps soften the bumps.

Lasers may work when moisturizer and medicine fail: A laser or light treatment may be used to treat keratosis pilaris. Your dermatologist may recommend one type of laser to reduce the swelling and redness. Another type of laser may improve your skin’s texture and reduce discoloration, including the brown spots that may appear when the bumps clear.

To get the best results from the laser treatments, your dermatologist may add a few microdermabrasion sessions to your treatment plan.

Key facts about treatment: When treating keratosis pilaris, it helps to keep the following in mind:

• Clearing takes time. If you fail to see improvement after following your treatment plan for 4 to 6 weeks, tell your dermatologist.
• Some patients need to try a few treatments before they find one that works.
• To continue seeing results, you’ll need a maintenance plan. 

About the maintenance plan: Treatment cannot cure keratosis pilaris, so you’ll need to treat your skin to keep the bumps under control. Your maintenance plan may be as simple as using the medicine twice a week instead of every day. Another option may be to switch to a non-prescription moisturizing cream.

What is the outcome for people with keratosis pilaris?

For many people, keratosis pilaris goes away with time — even if you opt not to treat it. Clearing tends to happen gradually over many years. There is no way to know who will see keratosis pilaris clear.

References:
Alai AN. “Keratosis pilaris medical care.” Medscape. Last updated June 19, 2014.
Ciliberto H, Farshidi A, et. al. “Photopneumatic therapy for the treatment of keratosis pilaris.” J Drugs Dermatol. 2013 Jul 1;12(7):804-6.
Ibrahim O, Khan M, et. al. “Treatment of keratosis pilaris with 810-nm diode laser: Randomized clinical trial.” JAMA Dermatol. 2014 Nov 5. [Epub ahead of print].
Lee SJ, Choi MJ, et. al. “Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.” J Cosmet Laser Ther. 2013 Jun;15(3):150-4.
Park J, Kim BJ, et. al. “A pilot study of Q-switched 1064-nm Nd:YAG laser treatment in the keratosis pilaris.” Ann Dermatol. Aug 2011; 23(3): 293–298.
Saelim P, Pongprutthipan M, et. al. “Long-pulsed 1064-nm Nd:YAG laser significantly improves keratosis pilaris: a randomized, evaluator-blind study.” J Dermatolog Treat. 2013 Aug;24(4):318-22.
Yang G, Bordeaux J, et. al. “Prospective right/left comparison of azeleic acid and cetaphil for treatment of keratosis pilaris.” J Am Acad Dermatol. 2012 Apr;66(4) Supp. 1: AB167.

Keratosis pilaris: Tips for self-care

Treating keratosis pilaris at home

Some people see clearer skin by treating their keratosis pilaris at home. This 3-step plan may be all you need. Dermatologists recommend following this plan every day until you see clearer skin.

1. Exfoliate gently: When you exfoliate your skin, you remove the dead skin cells from the surface. You can slough off these dead cells gently with a loofah, buff puff, or rough washcloth. Avoid scrubbing your skin, which tends to irritate the skin and worsen keratosis pilaris.
    
2. Apply a product called a keratolytic: After exfoliating, apply this skin care product. It, too, helps remove the excessive buildup of dead skin cells. Another name for this product is chemical exfoliator. Whether it’s called a keratolytic or chemical exfoliator, you’ll want to use a product that contains one of the following ingredients:
   
   • Alpha hydroxyl acid
   • Glycolic acid
   • Lactic acid
   • A retinoid (retinol, tretinoin, adapalene, tazarotene)
   • Salicylic acid
   • Urea
   
   Take care to use this product as described in the directions. Applying more or using it more often than indicated can cause raw, irritated skin.
   
   Even when you follow the directions, your skin can become too dry or irritated. If this happens, stop using the product for a few days.
    
3. Slather on moisturizer: Using a keratolyic dries the skin, so you’ll want to apply a moisturizer afterwards. Dermatologists recommend using an oil-free cream or ointment to help prevent clogged pores.
   
   You want to apply the moisturizer:
   
   • After bathing
   • When your skin feels dry, and at least 2 or 3 times a day

Keratosis pilaris can be stubborn. If it remains despite home treatment, seeing a dermatologist can help.

Because you cannot cure keratosis pilaris, you’ll need to follow a maintenance plan. This often involves treating your skin a few times a week.

You’ll also need to take some precautions to prevent flare-ups. The following tips can help.

Tips to prevent flare-ups

Moisturize your skin: Keratosis pilaris often flares when the skin becomes dry. Applying a moisturizer can prevent dry skin.

For best results when using a moisturizer: Select a thick oil-free cream or ointment rather than a lotion. Use a moisturizer that contains urea or lactic acid. Apply it to damp skin within 5 minutes of bathing. Slather it on when your skin feels dry.

Rethink hair removal: Shaving or waxing skin with keratosis pilaris can cause more bumps. Laser hair removal can remove the hair without causing a flare-up.

Take short showers and baths: To prevent drying your skin, take a short (20 minutes or less) bath or shower and use warm rather than hot water. Also, limit bathing to once a day. 

Use a mild cleanser: Bar soap can dry your skin.

Skip the self-tanner: These tend to make the bumps more obvious rather than hide them.

Plug in a humidifier when the air feels dry: This can help prevent dry skin.

Images from Thinkstock

Reference:
Alai AN. “Keratosis pilaris surgical care.” Medscape. Last updated June 19, 2014.

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