Keratosis pilaris is an annoying, but generally not serious condition that can affect the skin of anyone, resulting in the skin appearing bumpy, and occasionally red. The condition is quite common in children, often resolving as kids age, but some people continue to be affected by keratosis pilaris for most of their lives. Though there’s no treatment that will take away the condition, and there’s normally no need to treat the condition, there are some medicines and some self-care tips that can help reduce the look of bumpy skin.
You’ll find that keratosis pilaris occurs on the arms, legs, buttocks and face. It often occurs in patches, so that a whole area of skin will look like it has constant goosebumps. The skin may also feel rough or sandpapery. Unless irritated by other things, these bumps don’t tend to itch, but the appearance may be annoying to some, especially when bumps appear on the face where they actually can scar the skin.
What causes keratosis pilaris is a build up of the protein keratin. It can form plugs in hair follicles, resulting in the skin’s bumpy appearance. Often there is no identifiable reason why people get the condition, though in some cases, if your parents had it, you’re more genetically inclined to have it too. It is not caused simply by skin being dry, as many think, but dry skin can cause the bumps to have an even rougher feel.
Diagnosis can usually be made at a doctor’s office, and a dermatologist will definitely be able to identify the condition, usually by examining the little skin plugs, made by keratin build up. Once the condition is diagnosed, unless it is causing considerable concern about appearance, prescribed medical treatment is usually unnecessary. When a person wants to minimize the look of the condition, any of the following might be prescribed:
Retinoid or Vitamin A creams, which can help unplug hair follicles.
Creams or Lotions with Urea, a urine protein, which can soften the skin and help reduce any skin irritation caused by the condition.
Topical corticosteroids usually of low strength may be used on areas that might scar, like the face.
Ammonium lactate, which can soften the plugs and the overall feel of the skin.
These treatments have to be applied daily in order to see reduction in the appearance of keratosis pilaris, and they won’t remove or cure the condition. For those who would prefer home treatment, it’s important to realize that scrubbing the skin roughly can actually make the problem worse. It’s recommended that you don’t use skin sloughing products, and that you towel off very gently after showers.
The best over the counter cream to treat keratosis pilaris is any moisturizer that contains lactic acid. Lactic acid tends to act on keratin and remove it from the skin. Getting a little, but not too much sun, can help too. Many people find the condition gets better over summer, but comes back with a vengeance during the other seasons. Unless any of the skin bumps show signs of infection or irritation, follow up visits with a doctor after diagnosis are usually not required, unless you’re on prescription medications to treat the condition.
In view of the described genetic predisposition and possible genetic etiology of keratosis pilaris (KP), no cure or universally effective treatment is available. Inconsistent remissions and variations with seasons and hormonal states (eg, pregnancy) are described. Although symptoms usually remit with increasing age, this is not always the case. Some cases clear spontaneously without treatment.
Many treatment options and skin care recipes are available for treating keratosis pilaris. Many patients have very good temporary improvement following a regular skin care program. As a general rule, treatment needs to be continuous. Because no single therapy is effective, the list of potential lotions and creams is long. Importantly, keep in mind that as with any condition, no therapy is uniformly effective in all people. Complete clearing may not be possible.
General measures to prevent excessive skin dryness, such as using mild soap-less cleansers, are recommended, and lubrication is the mainstay of treatment for nearly all cases.
Best results may be achieved with combination therapy.
Mild cases of keratosis pilaris may be improved with basic lubrication using over-the-counter moisturizer lotions.
Additional available therapeutic options for more involved cases of keratosis pilaris include lactic acid lotions, alpha hydroxy acid lotions, salicylic acid, and topical steroid creams, retinoic acid products such as tretinoin, tazarotene, and adapalene. Specially mixed “designer” compound creams with multiple different combined ingredients can also be prescribed by physicians.
The affected area may be washed once or twice a day with a gentle cleanser such as Dove. Acne-prone skin may benefit from more therapeutic cleansers such as GlySal, Proactiv, salicylic acid, or benzoyl peroxide.
Lotions should be gently massaged into the affected area 2-3 times a day. Irritated or abraded skin should be treated only with bland moisturizers until the inflammation resolves.
Occasionally, physicians may prescribe a 7- to 10-day course of a medium potency, emollient-based topical steroid cream to be applied once or twice a day for inflamed, red rash areas. Once the inflammation has remitted, the residual dry rough bumps may be treated with a routine of twice-daily application of a compounded preparation of 2-3% salicylic acid in 20% urea cream.
Intermittent dosing of topical retinoids (eg, weekly or biweekly) seems to be quite effective and well tolerated, but usually the response is only partial. After initial clearing with stronger medications, patients may then be placed on a milder maintenance regimen.
Persistent skin discoloration, termed hyperpigmentation, may be treated with fading creams such as hydroquinone 4%, kojic acid, and azelaic acid 15-20%. Special compounded creams for particularly resistant skin discoloration using higher concentrations of hydroquinone 6%, 8%, and 10% may also be formulated by compounding pharmacists. Higher concentrations of hydroquinone may be irritating and carry an increased risk of adverse effects, including ochronosis.
Keratosis pilaris may be treated with topical immunomodulators such as pimecrolimus or tacrolimus. Although these products are approved for atopic dermatitis and eczema, their use would be considered off label for keratosis pilaris. These may be used in more resistant cases or when the patient has considerable skin redness or inflammation.
Photodynamic therapy using aminolevulinic acid and blue light (417 nm) has been anecdotally reported as effective, but this successful use of off-label photodynamic therapy requires confirmation.
Severe cases of keratosis pilaris have been treated orally with isotretinoin pills for several months. Isotretinoin is generally a very potent oral medication reserved for severe, resistant, or scarring cases of acne. Its use in keratosis pilaris would be considered off label and not routine.
Vitamin D (calcipotriol) is not effective for keratosis pilaris, but clinical trials have found it moderately effective for ichthyosis.
As with most treatments for keratosis pilaris, data exist only in the form of small group observations and anecdotal reports. Because keratosis pilaris is generally a chronic condition that requires long-term maintenance, most therapies would require repeated or long-term use to maintain results.