What is Keratosis Pilaris?
Keratosis pilaris is a common, inherited skin disorder that is characterized by tiny red and rough bumps on the surface of the skin. Often referred to as "chicken skin," the bumps appear on the upper arms, upper thighs, cheeks and buttocks. They are harmless but can be irritating, itchy, and persistent. KP can feel dry and sandpaper-like and it is often very challenging to treat.
KP affects more than half of children, most teens, and many adults, including more than 75% of individuals who have atopic dermatitis (eczema) or ichthyosis vulgaris (a genetic skin condition causing very dry skin). Symptoms appear as early as infancy, but more commonly in the teenage years. For some people KP improves with age, but for many people it persists and requires a smart, gentle, and safe skincare routine.
SymptomsKeratosis pilaris is identified by tiny rough bumps that appear symmetrically on the arms, thighs, cheeks (KP Rubra), upper back, and/or buttocks. These bumps usually feel dry and rough, and they sometimes appear inflamed, especially in drier climates or when scratched. On lighter skin, KP bumps appear red and on darker skin, they are typically brown.
Keratoris Pilaris on upper arm
Keratoris Pilaris on thigh
Keratoris Pilaris on face
CausesMost recent research shows that skin with keratosis pilaris lacks sebaceous glands, which secrete oils, fats, and acids that help promote healthy hair follicle growth and skin turnover. This leads to “plugged” follicles, and the bumps of KP follow, often along with redness and inflammation. Dry climates, irritating products (including strong acids), and certain periods of life including pregnancy and menopause can worsen KP. Certain medicines such as Cyclosporine and chemotherapy treatments like vemurafenib can also cause KP. There are also genetic syndromes that cause KP.
How Do I Know If I Have KP?
People of all ages can have keratosis pilaris, and it usually runs in families. It first shows up in early childhood or around the time of puberty, and it can continue into adulthood. People with atopic dermatitis or ichthyosis vulgaris very often have KP. However, it’s sometimes mistaken for other common skin conditions like folliculitis, eczema, and acne, so it’s helpful to consult a board certified dermatologist, who will be able to properly diagnose it.
How to Treat Keratosis Pilaris
For some people, keratosis pilaris goes away on its own as they reach adulthood. But for most, it lasts a lifetime. Although it’s not harmful for the skin, KP can be both irritating and embarrassing. Many people with KP-prone skin find it helpful to know about the different options for treatment and management so that they can find the right approach for their own skin.
MoisturizersKeeping skin hydrated and restoring natural lipids and water density is crucial for keratosis pilaris. Choose a moisturizer that has fewer than 10 ingredients and has a high percentage of coconut oil, wax esters, and water. Look for a formula that is thick (these typically come in jars rather than squeeze or pump bottles) and be sure to apply it daily. It’s best to moisturize your KP-prone areas just after you shower or bathe, while skin is still damp.
Exfoliators and PeelsFor some people, gentle exfoliation can be helpful for reducing the symptoms of keratosis pilaris, especially the bumpiness. Look for a cream or scrub with a low concentration of AHAs, BHAs, PolyHydroxy Acid, or Urea. Stick to 10% or lower, because higher concentrations can irritate skin and worsen the symptoms KP. We also recommend avoiding products that use salicylic acid, which works best for skin with high lipid content (the opposite of KP).
If your keratosis pilaris is itchy or very inflamed, your dermatologist may prescribe a mild steroid cream or non-steroidal anti-inflammatory cream. Retinoid creams can also sometimes be used if over-the-counter products don’t offer relief, but keep in mind that all of these prescription treatments should be used only periodically.
LaserTreating some cases of KP with certain energy devices like a pulse-dye laser has been shown to reduce redness associated with the condition when done by a board certified dermatologist. However, recent research reveals that lasers alone do not resolve the bumpiness caused by KP.
DietMany find benefit with various dietary changes, but there is no general trend that can be recommended. Gluten-free diet has helped some but not others and the same with a low-glycemic diet.
Sun/TanningPlease do not use tanning beds. Any possible benefit is outweighed by the incredible risk of melanoma that increases quickly with every tanning session.
Vitamins / MineralsThere are no great studies on this topic. Anecdotally, many have found a benefit from oral intake of Vitamin D and Vitamin A. While others have found no benefit at all from any dose of Vitamins D or A. We would caution against any large doses of either vitamin unless your primary care doctor recommends either.
How to Manage Keratosis Pilaris Over Time
Ensure that you have the correct diagnosis by a board certified dermatologist. In addition to products and other treatments designed to help keratosis pilaris, there are lifestyle changes you can make to help keep the symptoms at bay.