Keratosis pilaris

Keratosis pilaris is a benign skin condition that causes small, hard bumps to appear on the skin, particularly on the upper arms, thighs, cheeks, and buttocks. This condition is harmless and typically does not require treatment, often resolving on its own by age 30. Proper skin care, including moisturising and exfoliation, can improve the appearance of keratosis pilaris.

What is Keratosis Pilaris?

Keratosis pilaris is a common skin condition that affects many people. The condition is caused by the accumulation of keratin, a protein that forms the epidermis (skin's outer layer), hair, and nails. This buildup forms a plug that blocks the openings of hair follicles, leading to small, rough bumps on the skin. While the exact keratosis pilaris cause is not fully understood, it is believed to be associated with a genetic mutation in a protein called filaggrin, which causes the skin to produce too much keratin. Apart from genetic factors, other skin conditions such as atopic dermatitis and ichthyosis also play a major role in causing this condition. Dry skin tends to worsen keratosis pilaris, and hormonal changes can cause flare-ups during pregnancy and puberty.

Keratosis pilaris can develop at any age, though it’s more frequently seen in young children. Common signs include:

• Tiny, painless bumps on the upper arms, thighs, cheeks, or buttocks.
• Dry, rough skin in the areas where bumps appear.
• Symptoms that worsen during dry, low-humidity conditions, especially in winter.
• Bumps that feel like sandpaper or resemble goosebumps or “strawberry skin.”

In most cases, you’ll notice these rough patches without any other discomfort. However, some people experience:

• Itchy or dry skin: often on the upper arms, thighs, or buttocks, making the skin feel tight or irritated.
• Irritated bumps: friction or scratching can make the bumps more inflamed or discolored, known as frictional lichenoid dermatitis.
• Worsening in cold, dry weather: dry air often intensifies the rough texture and appearance.

These symptoms can resemble other skin conditions such as eczema, psoriasis, allergies, or fungal infections. If the bumps persist or cause concern, it’s best to consult a healthcare provider for proper diagnosis and advice.

Keratosis pilaris occurs when hair follicles become clogged with keratin, a natural protein found in the skin, hair, and nails. The exact cause of this keratin buildup isn’t fully understood, but it’s believed to have a genetic link. If your parents have keratosis pilaris, you’re more likely to develop it too. This condition is harmless and non-contagious, meaning it cannot be spread to others or caught by someone else.

The factors that may contribute to the development of keratosis pilaris include:

• Dry skin, which can worsen the condition
• Genetic predisposition, as it often runs in families
• Other skin conditions, such as eczema (atopic dermatitis) and ichthyosis vulgaris
• Vitamin A deficiency
• Certain medical conditions, such as hypothyroidism, Cushing's disease, and diabetes
• Obesity
• Asthma and hay fever

Preventing keratosis pilaris involves a combination of skincare routines and lifestyle adjustments. Some of these prevention strategies are listed below:

• Moisturise Regularly: Since dry pilaris often exacerbates keratosis skin, maintaining moisturised skin is essential. Keeping the skin well-moisturised prevents flare-ups of keratosis pilaris. This can be achieved by applying a thick, oil-free cream, ointment, or moisturiser, especially after bathing or showering while the skin is still damp. Look for moisturisers that contain ingredients like urea, lactic acid, or alpha-hydroxy acids (AHAs).

• Use Mild Cleansers: Using mild cleansers that do not contain soap is also recommended, as harsh soaps can strip the skin of its natural oils and worsen the condition.

• Maintain a Humid Environment: Using a humidifier can help add moisture to the air, which is particularly beneficial during dry winter months when keratosis pilaris tends to worsen.

• Avoid Irritating Products: Skip self-tanners and other products that can make the bumps more visible or irritate the skin further.

• Gentle Exfoliation: Regular, gentle exfoliation using a loofah, buff puff, or rough washcloth can help remove dead skin cells without irritating the skin.

Diagnosing keratosis pilaris is usually done through a simple physical examination. Your healthcare provider can identify it by looking at the location and texture of the bumps. Additional tests are rarely needed. However, they may recommend an allergy test or a skin biopsy if the diagnosis is uncertain.

Common Locations:

Keratosis pilaris bumps typically appear where hair follicles are present, especially on the:

• Upper arms
• Thighs
• Cheeks, neck, or under the eyes
• Buttocks
• Back, chest, and forearms

Key Characteristics:

• Painless: If a bump hurts when touched, it may be another condition.
• Dry or itchy: The surrounding skin may feel tight, flaky, or irritated.
• Rough texture: The bumps often feel coarse, like sandpaper.
• Discolouration: Bumps may vary in colour: skin-toned, red, white, brown, or black, depending on your natural skin tone.

Recognising these traits can help you distinguish keratosis pilaris from other skin conditions. If unsure, a healthcare professional can offer clarity and treatment options.

Keratosis pilaris is a chronic condition that may require ongoing management. Keratosis pilaris treatment focuses on reducing the appearance of the bumps and improving the overall texture of the skin. Treatment options include self-care measures, topical treatments, and, in some cases, medical procedures.

1. Self-Management
   • Moisturise the skin daily with a non-fragranced, cream-based moisturiser
   • Avoid thick, tight, or abrasive clothing that can cause friction and irritation
   • Use soap-free body cleansers
   • Avoid hot and prolonged baths and showers
   • Do not pick at the bumps
   • Use a humidifier to add moisture to the air
2. Topical Treatments
   • Keratolytics, such as lactic acid, ammonium lactate, salicylic acid, and urea, to break down the keratin buildup (exfoliation) and smooth the skin
   • Medicated creams or gels, such as retinoids (vitamin A) and steroid creams, to prevent clogged pores and reduce inflammation and itching
3. Other Treatments
   • Laser therapy to reduce redness and inflammation
   • Exfoliation, such as with a loofa or chemical exfoliants, to remove dead skin cells and unclog hair follicles

Be patient and consistent with your treatment plan, as it may take several weeks or months to see noticeable improvements. If you have concerns or your condition worsens, consult with a dermatologist for personalised advice.

Living with keratosis pilaris can be challenging, but by following the following tips and making necessary lifestyle adjustments, you can effectively manage keratosis pilaris and minimise its impact on your daily life.

1. Managing Dry Skin

Dry skin can worsen your symptoms of keratosis pilaris. You can manage dry skin in the following ways:

• Don't Scratch or Rub the Bumps: Avoid scratching or rubbing the bumps as this can lead to irritation and potentially permanent scars. If the itching becomes unbearable, try applying a cold compress or using an over-the-counter anti-itch cream to alleviate the discomfort.
• Use Moisturisers: Apply moisturiser several times a day, especially after bathing or showering, to keep your skin hydrated.
• Use Warm Water: When showering or bathing, use warm water instead of hot water, as the latter can strip the skin of its natural oils and exacerbate keratosis pilaris. Limit your time in the water to prevent further drying of the skin.
• Use a Humidifier: Dry air can worsen keratosis pilaris. Using a humidifier in your home can help add moisture to the air and keep your skin hydrated.

2. Gentle Exfoliation

Gently exfoliating or removing your affected skin can also have a beneficial effect:

• Use a Loofah or Buff Puff: Gently exfoliating your skin with a loofah or buff puff can help remove dead skin cells and unclog hair follicles. Be careful not to scrub too hard, as this can irritate the skin.
• Try a Chemical Exfoliant: Products containing AHAs or beta-hydroxy acids (BHAs) can help exfoliate the skin and improve the appearance of keratosis pilaris. Start with a low concentration and gradually increase as tolerated. However, always consult your doctor before using such products on your skin.

3. Choosing the Right Clothing

Keep the following points in mind regarding the right clothing for keratosis pilaris:

• Wear Loose, Breathable Fabrics: Tight clothing can trap heat and moisture, which can irritate the skin and worsen keratosis pilaris symptoms. Opt for loose-fitting, breathable fabrics made from natural fibres like cotton to reduce friction and allow your skin to breathe.
• Avoid Rough, Irritating Materials: Rough fabrics like wool can irritate your skin and exacerbate keratosis pilaris. Choose soft, smooth materials that are gentle on your skin.

4. Maintaining a Healthy Lifestyle

Try to incorporate the following lifestyle modifications:

• Stay Hydrated: Drinking plenty of water helps keep your skin hydrated from the inside out. Aim for at least eight glasses of water per day.
• Eat a Balanced Diet: A diet rich in fruits, vegetables, whole grains, and healthy fats can help support healthy skin. Some studies suggest that omega-3 fatty acids may be beneficial for keratosis pilaris.
• Manage Stress: Stress can worsen skin conditions like keratosis pilaris. Practice stress-reducing techniques like meditation, deep breathing, or yoga to help manage stress levels.

While keratosis pilaris is a harmless skin condition, there may be times when you need to consult a doctor.

• If you notice any changes in the appearance of your skin or experience discomfort, it's essential to seek medical advice. For instance, if your keratosis pilaris symptoms worsen or become painful or if you develop an infection, it's crucial to contact your doctor promptly.

• Additionally, if you have any concerns about your skin or are unsure whether you have keratosis pilaris or another skin condition, it's always best to consult a doctor. They can provide an accurate diagnosis and advise you on the best course of action. Your doctor can also guide you on the most effective medicine for keratosis pilaris and help you manage your symptoms effectively.

• Keratosis pilaris is a harmless skin condition that is not contagious or infectious.

• The condition is more common in people with dry skin or eczema and tends to run in families.

• Various treatment options like gentle exfoliation, moisturising, and using keratolytic agents (salicylic acid or lactic acid) can help manage the symptoms and improve the appearance of the skin.

• If your symptoms persist or worsen despite self-care measures, it's essential to consult a doctor for further advice and treatment.