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Definition
Keratosis pilaris (ker-uh-TO-sis pil-AIR-is) is a common skin condition that causes rough patches and small, acne-like bumps, usually on the arms, thighs and buttocks. Keratosis pilaris bumps are usually white, sometimes red, and generally don't hurt or itch. Keratosis pilaris can be frustrating because it's difficult to treat. Prescription medications and self-care measures can improve the appearance of your skin.
Though you may not like the sandpaper-like appearance of your skin, keratosis pilaris isn't serious and doesn't have long-term health implications. In fact, though some cases may persist, keratosis pilaris usually disappears by age 30.
Symptoms
Signs and symptoms of keratosis pilaris include:
- Small, acne-like bumps
- Painless, skin-colored bumps that can, at times, be red and inflamed
- Dry, rough patches
- In some cases, itchiness
Keratosis pilaris usually appears on the upper arms, legs or buttocks, but it can also appear on the face, where it closely resembles acne. The small size of the bumps and its association with dry, chapped skin distinguish keratosis pilaris from pustular acne. Unlike elsewhere on the body, keratosis pilaris on the face may leave small scars.
Though quite common with young children, keratosis pilaris can occur at any age. It may improve, especially during the summer months, only to later worsen. Gradually, keratosis pilaris usually resolves on its own.
When to see a doctor
Keratosis pilaris isn't a serious medical condition, and treatment usually isn't necessary. However, if you're concerned about the appearance of your skin, consult your family doctor or a specialist in skin diseases (dermatologist). He or she can often make a diagnosis by examining your skin and the characteristic scaly plugs.
Causes
Keratosis pilaris results from the buildup of keratin — a hard protein that protects your skin from harmful substances and infection. The keratin forms a scaly plug that blocks the opening of the hair follicle. Usually many plugs form, causing patches of rough, bumpy skin.
Why keratin builds up is unknown. But it may occur in association with genetic diseases or with other skin conditions, such as ichthyosis vulgaris or atopic dermatitis. Keratosis pilaris also occurs in otherwise healthy people. Dry skin tends to worsen this condition.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist in skin diseases (dermatologist).
Because appointments can be brief, and because there's often a lot to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions beforehand will help you make the most of your appointment. List your questions from most important to least important in case time runs out. For keratosis pilaris, some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- What are other possible causes for my symptoms?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- Is there a generic alternative to the medicine you're prescribing me?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you several questions. Being ready to answer them may reserve time to go over any points you want to discuss more. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do other family members have similar skin changes?
- Do you have a history of asthma or hay fever or other allergies?
- Do you have eczema now or in the past?
Tests and diagnosis
There is no laboratory test or skin test commonly used to diagnose keratosis pilaris. Instead, it's typically diagnosed based on an examination of your skin and a review of your medical history. Your doctor will ask questions about your signs and symptoms.
Treatments and drugs
No single treatment universally improves keratosis pilaris. Most options, including self-care measures and medicated creams, focus on softening the keratin deposits in the skin.
Treatment of keratosis pilaris can include the following medications:
- Topical exfoliants. Medicated creams containing alpha-hydroxy, lactic or salicylic acid or urea moisturize and soften dry skin while helping to loosen and remove dead skin cells. Depending on their strength, certain creams are available over-the-counter and others require a prescription. Your doctor can advise you on the best option for your skin. The acids in these creams may cause redness, stinging or skin irritation, and therefore they aren't recommended for young children.
- Topical corticosteroids. These anti-inflammatory drugs help decrease cell turnover by suppressing the immune system. Low-potency corticosteroid ointments, such as hydrocortisone or derivatives, are usually recommended for sensitive areas such as your face and for treating widespread patches. Doctors usually prescribe corticosteroids for short-term treatment or for temporary relief of symptoms. They aren't used as long-term treatment due to potential side effects from absorbing stronger corticosteroid creams or thinning of the skin. Topical corticosteroids may also cause local burning, itching or irritation.
- Topical retinoids. Derived from vitamin A, retinoids work by promoting cell turnover and preventing the plugging of the hair follicle. Retinoids may be an effective treatment, but they can cause bothersome skin irritations, such as severe dryness, redness and peeling. Tretinoin (Retin-A Micro, Avita) and tazarotene (Tazorac) are examples of topical retinoids.
Using a medication regularly may improve the appearance of your skin. But if you stop, the condition returns. And even with medical treatment, keratosis pilaris tends to persist for years.
Lifestyle and home remedies
Self-help measures won't cure keratosis pilaris, but they can help improve the appearance of your skin. You may find these measures beneficial:
- Go easy on your skin. Vigorous scrubbing or removal of the plugs may irritate your skin and aggravate the condition.
- Gently dry off. After washing or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on the skin.
- Use a moisturizing lotion or lubricating cream. While your skin is still moist from bathing, apply a moisturizer that contains urea or propylene glycol, chemicals that soften dry, rough skin.
- Try lactic acid. Apply an over-the-counter product that contains lactic acid twice daily. Lactic acid helps remove extra keratin from the surface of the skin.
- Use a humidifier. A portable home humidifier or one attached to your furnace will add moisture to the air inside your home.
Prevention
Although there's no way to prevent keratosis pilaris, you can take steps to keep your skin moist and healthy:
- Moisturize your skin. Moisturizers provide a seal over your skin to keep water from escaping. Thicker moisturizers work best, such as over-the-counter brands Eucerin and Cetaphil.
- Use warm water and limit bath time. Hot water and long showers or baths remove oils from your skin. Limit your bath or shower time to about 15 minutes or less, and use warm, rather than hot, water.
- Avoid harsh, drying soaps. Choose mild soaps that have added oils and fats, such as Neutrogena, Basis or Dove. Avoid deodorant and antibacterial detergents, which are especially harsh. You might want to experiment with several brands until you find one that works particularly well for you. A good rule of thumb is that your skin should feel soft and smooth after cleansing, never tight or dry.
- Pat dry. After washing or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on the skin. Immediately moisturize your skin with an oil or cream.
- Use a humidifier. Low humidity dries out your skin. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home. Portable humidifiers come in many varieties. Choose one that meets your budget and any special needs. And be sure to keep your humidifier clean to ward off bacteria and fungi.
Last Updated: 2010-07-10
