Keratosis Pilaris - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Keratosis Pilaris or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Keratosis pilaris is a common, benign skin condition characterized by the appearance of multiple small firm skin-colored bumps on the lateral aspect of the upper arms and sometimes thighs. There can be surrounding redness. The bumps can resemble goosebumps and are sometimes referred to by the lay population as "chicken skin". They can cause the skin to have a sandpapery feel when touched. These bumps can also be seen on the face along the outer cheeks of children.
The asymptomatic bumps occur due to the harmless buildup of keratin in hair follicles. The condition usually improves with age and is a trait that is often seen in multiple family members. About 10% of the population carries this trait but there is an increased incidence in people with eczema (atopic dermatitis).
The diagnosis of keratosis pilaris is easily made by a dermatologist based on its appearance. No biopsy is necessary. The diagnosis is further supported by obtaining a history of other family members with a similar condition.
Treatment is not necessary but patients often seek treatment because of the rough feel, the bumpy appearance of the skin, or the accompanying redness. The appearance and texture can be improved with the use of a topical moisturizing lotion that contains filaggrin-like peptides and ceramides (Cetaphil Restoraderm) or topical keratolytic such as moisturizing lotions that contain 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 readily available over the counter without a prescription. Roughness and bumps reduce significantly after about 2 weeks with regular twice-daily use. If improvement is not seen with these medicated moisturizers, a higher strength of these ingredients or prescription topical retinoids, which are commonly used for acne treatment, can be applied. Gentle physical exfoliation can also be performed for resistant lesions through in-office microdermabrasion.
It is important to know that lotions need to be used regularly to keep the condition under control; if the lotions are stopped the bumps will become prominent with a delay of about 2 weeks. Redness usually reduces at the same time as the skin becomes smooth but if it persists, pulsed dye laser treatment may be pursued. Several sessions spaced 4 weeks apart are often necessary to completely remove redness. Results are long-lasting.
Most people are assured by understanding the benign nature of the condition. However, when the appearance of these bumps or surrounding redness is disturbing, treatment may be started. Many will treat during the warmer months of the year when they wear short sleeves or in anticipation of an important event. In such cases, treatment should begin at least 2 weeks prior to the date.
Some people will employ aggressive measures to remove the bumps of keratosis pilaris such as through the use of a loofah sponge or through picking. Not only are they rarely effective, but they are also discouraged due to the risk of skin irritation.
Keratosis pilaris is an inherited trait, therefore prevention is not possible at this time.