Keratosis Pilaris

Overview:

Keratosis pilaris is a common and harmless skin condition characterized by the presence of multiple small, firm, skin-colored bumps on the outer sides of the upper arms and sometimes thighs. These bumps may be accompanied by redness and can resemble goosebumps or “chicken skin” as referred to by the lay population. When touched, the affected skin may feel rough like sandpaper. In children, these bumps can also appear on the outer cheeks of the face.

These asymptomatic bumps occur due to the buildup of keratin in hair follicles and tend to improve with age. It is often seen in multiple family members, with around 10% of the population having this trait. There is a higher incidence of keratosis pilaris in individuals with eczema (atopic dermatitis).

Diagnosis:

The diagnosis of keratosis pilaris is easily made by a dermatologist based on its appearance, and no biopsy is necessary. The presence of other family members with a similar condition further supports the diagnosis.

Management:

Treatment is not necessary for keratosis pilaris, but individuals often seek treatment to address the rough texture, bumpy appearance, or accompanying redness. The appearance and texture of the skin can be improved by using topical moisturizing lotions that contain ingredients like filaggrin-like peptides and ceramides (e.g., Cetaphil Restoraderm) or keratolytic agents such as lotions containing citric acid, alpha hydroxy acid (e.g., Eucerin plus lotion or cream), ammonium lactate (e.g., AmLactin 5% lotion or cream), or urea (e.g., Ureacin 10% lotion).

These lotions are available over the counter without a prescription. Regular twice-daily use of these medicated moisturizers for about 2 weeks can significantly reduce roughness and bumps. If no improvement is seen, a higher strength of these ingredients or prescription topical retinoids commonly used for acne treatment can be applied. In resistant cases, gentle physical exfoliation through in-office microdermabrasion may be performed.

It is important to note that lotions need to be used regularly to maintain control over the condition. If discontinued, the bumps will become prominent again after a delay of about 2 weeks. Redness typically reduces as the skin becomes smoother, but if it persists, pulsed dye laser treatment may be considered. Several sessions spaced 4 weeks apart are often required to completely remove redness, and the results are long-lasting.

Coping:

Most people find reassurance in understanding that keratosis pilaris is a benign condition. However, when the appearance of the bumps or accompanying redness is bothersome, treatment can be initiated. Many individuals choose to treat during warmer months when they wear short sleeves or in preparation for important events. In such cases, treatment should begin at least 2 weeks prior to the desired date.

Some people may attempt aggressive measures to remove the bumps, such as using a loofah sponge or picking at them. However, these methods are rarely effective and are discouraged due to the risk of skin irritation.

Prevention:

Since keratosis pilaris is an inherited trait, prevention is not currently possible.