Keratosis pilaris

Keratosis pilaris is a common skin condition that causes rough patches and small, acne-like bumps, usually on the arms and thighs. 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.

Keratosis pilaris can be frustrating because it’s difficult to treat. Prescription medications and self-care measures can improve the appearance of your skin.

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 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.

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 the condition.

There is no laboratory test or skin test 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.

No single treatment universally improves keratosis pilaris. But 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 prescription medications:

  • Ammonium lactate (Lac-Hydrin). Available in a cream or lotion, 12 percent ammonium lactate reduces roughness and softens the keratin plugs. It won’t, however, lessen the redness caused by the condition.
  • Urea (Carmol, Keralac). Urea moisturizes and softens dry, rough skin. It also helps loosen and remove the dead skin cells. Side effects include redness, stinging and skin irritations.
  • Topical corticosteroids. These anti-inflammatory drugs help decrease cell turnover by suppressing the immune system. Low-potency corticosteroid ointments 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 treatments because of potential side effects.
  • 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.

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.