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Keratosis Pilaris: Someone You Know Has This Skin Problem

Keratosis pilaris is something I see in clinic multiple times every day. Depending on the scientific source, the rates are quoted at 20-80% of the population having it (35-50% are the most commonly quoted numbers). That’s crazy common! Here’s the scoop on it, so that the next time someone mentions the pesky little bumps, you can brilliantly add to the insight on the condition.

What is Keratosis Pilaris?

Keratosis pilaris is a condition that causes small, hard bumps on the skin. The bumps can be flesh colored, light colored, or slightly red in color. They often resemble tiny zits. The bumps most commonly are on the upper arms, but can happen on the thighs, buttocks and face. While harmless, the condition can be cosmetically annoying.

The fancy name stems from the word “keratin.” Keratin is a little protein that protects the skin (from things like infection). In the condition, the body’s keratin builds up a little too much and blocks the hair follicles. Once the follicle is blocked, a little bump forms.

Who gets it?

Anyone can get keratosis pilaris. The gender distribution is equal in males and females. It’s most common in teens and least common in the elderly. People with underlying skin issues (e.g., eczema, ichthyosis vulgaris) are more likely to have keratosis pilaris. Because dry skin can aggravate keratosis pilaris, it is more common in people who live in dry climates and during the winter (moving to the tropics is sounding better and better). There is also a genetic component to the condition. (I see it more commonly in families).

How do I treat it?

Keratosis pilaris is a chronic condition. There isn’t a cure, but there are things that you can do to help it look better.

  1. Improve the integrity of the skin. Keratosis pilaris is more common when the skin is compromised in some fashion (e.g., dry, underlying eczema). Improve the skin by using hypoallergenic products and good, thick moisturizers.
  2. Use lotions with topical exfoliants. These lotions have ingredients like hydroxyurea, lactic acid, and salicylic acid. They work by breaking down the keratin layer. My experience has been that failure rate with these creams is really high. The problem with them is that they can sting a little when you put them on. Most kids won’t tolerate creams that sting. A motivated teen (who is experiencing embarrassment from appearance) is a great candidate for using the creams. Commonly available lotions (that I’ve seen at my local stores) that fit the bill are Lac-Hydrin and AmLactin.
  3. Prescription topical retinoids. These products (e.g., Retin-A, Taxorac) are vitamin A derivatives that prevent plugging of the follicles. They are carefully prescribed in the pediatric world because they can cause a lot of redness and irritation, and they are linked to birth defects.
  4. Laser treatment. I added this for completeness sake. In practice, I’ve never seen anyone use lasers on kids with keratosis pilaris. Lasers can help with severe redness, but isn’t a cure and requires multiple sessions.

What’s the long term prognosis?

Many cases of keratosis pilaris improve with age (with peaking rates and severity in adolescence). So there is hope for your child that the condition will improve naturally as your child ages. As previously mentioned, it is completely benign. Aside from the cosmetic components, the bumps don’t cause a problem. The condition doesn’t turn into anything more serious with time.

So in case you had never heard of this little gem, start looking around. Chances are someone in your family (if not you, has the condition). In short-sleeve weather, if you’re observant, you’ll notice it on the backside of the upper arms on every 2nd or 3rd person you see.

Thanks to my patient (or rather his mom), who let me snap a pic of his arm to show you an example of keratosis pilaris.