Keratosis Pilaris

Keratosis pilaris is a very common harmless skin condition appearing as small, whitish bumps on the upper arms and thighs, especially of children and young adults. Individual lesions of keratosis pilaris begin when a hair follicle becomes plugged with keratin, a protein found in skin, hair, and nails.

Who's At Risk

Keratosis pilaris can affect people of any age, any race, and either sex. It is more common in females.

Keratosis pilaris usually starts in early childhood (by age 10) and can worsen during puberty. However, it frequently improves or even goes away by early adulthood.

Keratosis pilaris can affect 50-80% of teenagers and up to 40% of adults. Many people have a family history of keratosis pilaris. A large number of individuals with ichthyosis vulgaris (an inherited skin condition characterized by very dry, very scaly skin) also report having keratosis pilaris.

Signs & Symptoms

The most common locations for keratosis pilaris include the following:

• Backs of the upper arms

• Fronts and sides of the thighs

• Buttocks

• Cheeks

Tiny (1-2 mm) white to gray bumps occur, centered in the hair follicle. Sometimes, a thin, red ring may surround the white bump, indicating inflammation. The bumps all look very similar to one another, and they are evenly spaced on the skin surface.

Rarely, people with keratosis pilaris may complain of mild itching.

Keratosis pilaris tends to improve in warmer, more humid weather, and it may worsen in colder, drier weather.

Self-Care Guidelines

There is no cure for keratosis pilaris, though its appearance can be improved. It is often helpful to keep the skin moist (hydrated) and to use mild, fragrance-free cleansers, with daily applications of moisturizer.

Creams and ointments are better moisturizers than lotions, and they work best when applied just after bathing, while the skin is still moist. The following over-the-counter products may be helpful:

• Preparations containing alpha-hydroxy acids such as glycolic acid or lactic acid

• Creams containing urea

• Over-the-counter cortisone cream (if the areas are itchy) such as 1% hydrocortisone cream

Do not try to scrub the bumps away with a pumice stone or similar harsh material; these approaches may irritate the skin and worsen the condition.

Similarly, try to discourage your child from scratching or picking at the bumps, as these actions can lead to bacterial infections or scarring.

When to Seek Medical Care

Keratosis pilaris is not a serious medical condition and has no health implications. However, if self-care measures are not improving the appearance of the skin and it continues to bother your child there are some prescription options for treatment that could be considered.

Prescription Treatment Options

Treatments are aimed at controlling the rough bumps, not curing them. Keratosis pilaris bumps will come back if therapy is stopped.

Prescription treatments for keratosis pilaris sometimes include:

• Prescription-strength alpha- or beta-hydroxy acids (glycolic acid, lactic acid, salicylic acid)

• Prescription-strength urea

• A retinoid such as tretinoin or tazarotene

• High concentrations of propylene glycol

• If the skin is itchy or inflamed, the short-term prescription strength topical corticosteroid to reduce the inflammation may be considered

Usually, consistent home use of over-the counter creams is enough to manage the symptoms of keratosis pilaris.

References

• Feature image of KP on arm downloaded from https://dermnetnz.org/topics/keratosis-pilaris-images on 18 August 2022

Eczema

Eczema is the itch that rashes.

Managing the symptoms at home can seem can seem daunting, but patients can take control of this condition with changes to the daily routine and a stepwise approach when symptoms worsen.

Prevention (do this every day, always):

Apply moisturizer twice a day.

• Ointment - most effective, greasy, hard to apply. Won't burn the skin if it is scratched and dry.

• Creams - next most effective, thick.

• Lotions - least effective, easiest to apply.

Apply the maintenance steroid/immune modulator

Once a week, even if there are no symptoms, apply your lower potency steroid, or your immune modulator, as a proactive treatment to prevent flares.

Avoid drying the skin when bathing

• Shorter showers (not baths) are better.

• Use cooler water, less than 104 °F (40° C).

• Use a simple bar soap like an unscented Dove bar. Fancy soaps have fancy chemicals.

• Soap the Face, Armpits, Groin, Feet, Hands. Other areas do not need soap unless they are soiled or very dirty.

Flares 

Minor flare 🕯️

• Apply your lower potency steroid or your immune modulator to all affected areas twice a day, Monday through Friday. Take a break on the weekend to ensure the steroid continues to be effective.

• Continue to use moisturizers and avoiding long hot baths.

Severe flare 🔥 

• Apply stronger steroid twice a day, again Monday through Friday.

• As always, keep using the moisturizer, and maintain your normal skin therapies.

• When symptoms improve you should work your way back to Prevention in steps. First treat as a Minor flare and only reduce your use of regular steroid when your symptoms are back under control.

Links

Topical Steroid Potency Chart: National Psoriasis Foundation