Your Essential Guide to Keratosis Pilaris
Doctor’s Note
As dermatologists, we know that keratosis pilaris (KP) can be really frustrating. This skin condition can last for many years, causing discomfort, itchiness, and making people feel self-conscious. While it’s hard to completely cure KP, there are many treatments that can help relieve symptoms and make your skin look better.
What is Keratosis Pilaris?
Keratosis pilaris (KP), often called "chicken skin," is a common skin condition that causes tiny, rough bumps on the skin. These bumps are usually found on the upper arms, thighs, cheeks, or buttocks. They happen because of a buildup of keratin, a protein in hair, which blocks the hair follicles. While there is no cure for KP, it usually improves by age 30. Until then, proper skin care and treatments can help manage it.
Keratosis Pilaris Pictures
SSymptoms of keratosis pilaris (KP) include bumps in various colors such as flesh-colored, white, red, pink, brown, or black, along with slight discoloration around the bumps. These symptoms usually appear on areas with hair follicles, like the upper arms, thighs, cheeks, or buttocks, but not on the palms or soles.
Rough, tiny bumps that look like goosebumps
Dry, itchy, or irritated skin
A sandpaper-like texture to the affected areas
I often explain to my patients with keratosis pilaris (KP) that it is not exactly a “rash.” It’s just how their skin forms in certain areas, causing a bumpy texture. Although there are ways to reduce the appearance of the bumps, no medication or procedure can completely get rid of them. However, KP usually gets better on its own when patients reach their 30s.
What Causes Keratosis Pilaris?
Keratosis pilaris happens when keratin, a protein in hair, builds up and clogs pores, blocking hair follicles. The exact cause of this buildup is unknown. KP is more common in fair-skinned women, children, and teenagers who have:
Dry skin
Eczema
Hay fever
Seasonal allergies
Obesity
Hormonal changes during puberty and pregnancy can cause flare-ups. It often starts in late infancy or adolescence and usually clears up by age 30.
What Makes Keratosis Pilaris Worse?
Keratosis pilaris is a chronic skin condition that can get better and worse over time. Certain factors can make it worse, including:
Dry Skin: Low humidity and cold weather can dry out the skin.
Hot Showers: Long, hot showers can strip the skin of natural oils.
Tight Clothing: Wearing tight clothing can cause friction and irritation.
Harsh Soaps: Soaps and detergents with strong chemicals can dry out the skin.
Picking or Squeezing: Picking at the bumps can cause irritation, swelling, and scarring.
What Makes Keratosis Pilaris Better?
Keratosis pilaris is a skin condition that can get better or worse over time. Here are some ways to help lessen KP symptoms:
Moisturizing: Use creams with urea and glycerin to soften the skin. Thicker moisturizers work best and should be applied to wet skin right after a shower.
Warm Baths: Short, warm baths can help unclog pores. Keep bath time short to keep natural oils on your skin.
Humidifiers: Adding moisture to the air with a humidifier can help keep your skin hydrated.
Avoid Tight Clothes: Tight clothing can cause friction and irritation.
Gentle Skincare: Use mild soaps and avoid scrubbing too hard or trying to remove the bumps.
Sun Protection: Avoid too much sun, especially if you are using exfoliating products.
Diet: Eat foods rich in Omega-3 fatty acids, like salmon, walnuts, and flaxseeds.
Best Products for Keratosis Pilaris
In addition to the above, there are several strategies to reduce KP. They target different parts of the hair follicle:
Remove Dead Skin Cells: Acids (like lactic, salicylic, glycolic, etc.) and “physical exfoliation” (like loofahs, washcloths, etc.)
Reduce Inflammation: Topical steroids (like hydrocortisone).
Prevent Clogged Pores: Retinol.
Hair Removal: Laser.
If one treatment strategy isn't working, try another approach. Different treatments target various aspects of the condition, so what works for one person might not work for another. Experimenting with different options, such as switching from exfoliation to topical steroids or from retinol to laser treatments, can help you find the most effective solution for managing your keratosis pilaris.
Option 1: Remove Dead Skin Cells
In addition to gentle skincare and daily moisturizer, you can also use over-the-counter products to reduce the appearance of the bumps (they won't go away completely, but you can smooth them temporarily). To remove dead skin cells, here are some great exfoliating acids:
Most Gentle: Lactic Acid
Exfoliates + moisturizes. A very gentle acid. Choose this if you have very sensitive skin.
A Little Stronger: Salicylic Acid
Exfoliates deep into the pore. Gentle. Should not irritate skin too much.
Even Stronger: Glycolic Acid
A stronger and more irritating acid. Choose this if the above options have not worked for your skin.
Strongest: Multiple Acids + Scrubs
The most irritating + aggressive. For stubborn KP that does not respond to the above treatments.
Amlactin
Q: Everytime I go to the dermatologist for KP, they recommend Amlactin. Why?
A: When you become a dermatologist, you have to Pledge Allegiance to Amlactin every morning. Why is this? Lactic acid is a great molecule… it both gently exfoliates and moisturizes. This makes it PERFECT for sensitive skin that needs exfoliation. Glycolic acid can be irritating, so that is not really our favorite for KP. Amlactin is moisturizing and gentle exfoliating, which is why we recommend it all the time.
Option 2: Reduce Inflammation
In addition to removing dead skin cells, we can also use hydrocortisone to reduce inflammation. Hydrocortisone is a cream that helps calm down redness and irritation from KP. It can make the bumps look less noticeable. Use it as directed and only for short periods, because using it for too long can make your skin thinner. Be sure to apply a good moisturizer afterward to keep your skin hydrated and protected.
Option 3: Prevent Clogged Pores
In addition to getting rid of dead skin cells, we can also prevent clogged pores! We can do this with retinol. Retinol is a form of vitamin A that speeds up skin cell turnover, helping to unclog hair follicles, which are often blocked in KP. Regular use of a retinol-based product can reduce the appearance of bumps. It's important to start with a low concentration and moisturize as needed. Don't forget to use sunscreen, as retinol can make your skin more sensitive to the sun!
Olay Regenerist Retinol 24 Night Moisturizer
Retinol: Unknown %
Niacinamide: Soothes skin, targets pigmentation.
RoC Retinol Max Hydration Cream
Retinol: Unknown %
Hyaluronic Acid: Hydrates, plumps skin
Vitamin E: Moisturizer, antioxidant.
Neutrogena Retinol Pro+ 0.3% Night Cream
Retinol: 0.3%
Hyaluronic Acid: Hydrates, plumps skin.
Neutrogena Retinol Regenerating Cream
Retinol: 0.13%
Hyaluronic Acid: Hydrates, plumps skin.
Option 4: Laser Hair Removal
If the above methods aren't successful, we can consider laser therapy. Over the years, various laser treatments have been explored for treating KP. Here are some lasers to try:
CO2 Laser
This is not necessarily a hair removal laser, but it can help. CO2 laser treatment can improve the appearance of keratosis pilaris by reducing the bumps and smoothing the skin's texture. See the above pictures: Before Treatment, 4 Weeks After Treatment, and 12 Weeks After Treatment.
CO2 Laser Image: Vachiramon V, Anusaksathien P, Kanokrungsee S, Chanprapaph K. Fractional Carbon Dioxide Laser for Keratosis Pilaris: A Single-Blind, Randomized, Comparative Study. Biomed Res Int. 2016;2016:1928540. doi: 10.1155/2016/1928540. Epub 2016 May 9. PMID: 27247936; PMCID: PMC4876199.
Laser Hair Removal Image: Above: Li M, Bai Y, Duan Z, Yuan R, Liu X, Liu Y, Liang X, Wu H, Zhuo F. Efficacy and Safety of Long-Pulsed 755-nm Alexandrite Laser for Keratosis Pilaris: A Split-Body Randomized Clinical Trial. Dermatol Ther (Heidelb). 2022 Aug;12(8):1897-1906. doi: 10.1007/s13555-022-00771-5. Epub 2022 Jul 15. PMID: 35838863; PMCID: PMC9357583.
Laser Hair Removal (LHR)
In some cases, laser hair removal can also be beneficial for KP. LHR works especially well for dark hair. By targeting the affected areas, it can further improve the appearance and texture of your skin, making those pesky bumps less noticeable.
Keratosis Pilaris FAQs
Is Keratosis Pilaris Itchy?
It can be! Because the bumps get inflamed, the skin can become red/itchy. It's a very common symptom. We can temporarily treat the itch with topical steroids. You must be careful not to overuse a steroid, though!
Can Keratosis Pilaris Go Away?
Yes, Keratosis Pilaris goes away. It may be a while, though, as it tends to decrease in adulthood. In the meantime, we use the various treatments listed above to help manage the symptoms.
Where does Keratosis Pilaris Occur?
Keratosis Pilaris occurs on the upper arms, thighs, buttocks, face, back, forearms, and/or lower legs. Children may have keratosis pilaris on their hands or the tops of their feet.
Is Keratosis Pilaris Related to Gluten?
There are no studies linking keratosis pilaris to gluten. Some people report their keratosis pilaris resolved after starting a gluten-free diet. While there is no definitive cure for KP, diet and lifestyle choices have been known to improve the condition for some individuals.
Does Tanning Help Keratosis Pilaris?
Tanning may temporarily mask the appearance of keratosis pilaris (KP) by darkening the skin, but it's not a recommended treatment. Sun exposure can actually worsen KP by drying out the skin and causing more irritation. It's important to protect your skin with sunscreen and avoid excessive sun exposure to manage KP effectively.
Can I Get a Tattoo with Keratosis Pilaris?
Yes! KP can result in inflammation of the skin, so depending on the level of inflammation, the tattoo may take a bit longer to heal. Do your best to moisturize and minimize any redness before the procedure.
Does Laser Hair Removal Get Rid of Keratosis Pilaris?
Yes! Keratosis Pilaris results from dead skin cells clogging up the hair follicle. If you remove the hair follicle, there is less room for clumps to build up. See the example above!
Is there a Vitamin Deficiency with Small White Spots on Skin?
Yes! Vitamin A (found in carrots, sweet potatoes, etc.) deficiency can cause a KP-like rash. Vitamin A deficiency is relatively uncommon (at least in the US) and more likely KP is the result of genetics.