Keratosis Pilaris

Keratosis Pilaris (KP) is a very common skin condition that presents in childhood or adolescence but can also occur in infants. Clinically, KP presents as rough, raised, spiny bumps on arms, thighs, buttocks, and cheeks. It is equally common in all ethnic groups, in males and females, and it can affect up to 12% of children. KP improves in adulthood but can persist in some cases. 

The cause of KP is not completely understood, but in some inherited cases, it has been associated with gene mutations that are passed from parents to their offspring. These mutations cause the protein keratin to form horny plugs in the pores of hair follicles on the affected areas. The keratin plug can in turn cause mild inflammation and redness of skin around the plug. Most patients dislike the rough texture and appearance of their affected skin.

KP is often associated with other skin conditions like atopic dermatitis and ichthyosis vulgaris, and these conditions can present together with KP. All three mentioned conditions worsen in dry, winter months and with pregnancy. 

There are several variants of KP:

• “Keratosis pilaris rubra” is when redness around the spiny bumps is significant, especially around the cheeks, forehead and neck.  
• “Erythromelanosis follicularis faciei et colli” is when KP presents as dark, red bumps on the pores of temples, cheeks, sides of neck, and arms primarily in adolescents and young adults. 
• “Keratosis pilaris atrophica” is a group of inherited disorders in which the KP presents on cheeks and lateral eyebrows with inflammation, scarring, and potentially permanent hairloss.

KP waxes and wanes throughout adolescence and frequently worsens in the winter months. The goal of treatment is to keep the bumps flat and treat any associated inflammation. All patients with KP should use gentle skin care and aggressive moisturization. Patients with both KP and eczema should control flares with preventative as well as active treatment measures. The most common prescribed treatment options are as follows:

• Keratolytics: Emollients that contain lactic acid, glycolic acid, salicylic acid, or urea can help soften and flatten the keratin plugs. These emollients are the first line therapy for KP. The bumps will remain flat as long as treatment is continued. The keratolytics can be in the form of lotions, creams, ointments, or cleansers.
• Retinoids: Topical retinoids such as tretinoin, adapalene, and tazarotene creams are the second line treatment for patients who fail to see improvement with keratolytics. Retinoids help to shed the overgrown keratin plug and keep the skin smooth. Systemic retinoids can be used as third-line treatment option if topical retinoids and keratolytics are insufficient.
• Topical steroids: Steroids can be used for treatment and control of inflammation for a short period of time. 
• Lasers: Combination treatments with lasers such as a pulsed-dye laser, long-pulsed 755-nm alexandrite laser, 810-nm long-pulsed diode laser, long-pulsed 1064-nm Nd:YAG laser can help flatten KP temporarily. Repeat treatments may be necessary to see lasting effects.
• Microdermabrasion: This is a cosmetic treatment can be offered in an outpatient setting to help flatten the bumps. Ongoing treatment is necessary to keep the bumps flat. Care should be taken as any abrasive procedures, especially in an area of active inflammation, can cause discoloration and even scarring. 

Our dermatologists can evaluate your skin and symptoms so a customized treatment plan can be developed for you.