Keratosis Pilaris

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

 

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 skin protein keratin to form horny plugs in the pores of hair follicles on affected areas. The keratin plug can in turn cause mild inflammation and redness of skin around the plug. Most patients complain of rough texture and unsightly appearance of their skin.

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

There are variants of KP. When redness around the spiny bumps is significant, especially around the cheeks, forehead and neck, the condition is referred to as "keratosis pilaris rubra".  

"Erythromelanosis follicularis faciei et colli"is a variant in which KP presents as red, dark bumps on pores, on temples, cheeks  and sides of neck, in addition to arms, primarily in adolescents and young adults. 

These must be distinguished from keratosis pilaris atrophica, a group of inherited disorders in which the KP presents on cheeks and lateral eyebrows, with inflammation, scarring and hairloss, which can be permanent.

The disease waxes and wanes throughout adolescence, worsening in winter months.Treatment is aimed at keeping the bumps flat and treating any inflammation. All patients with KP should use gentle skin care practices and products and aggressive moisturization, and control eczema flares with preventative as well as active treatment measures.  These are the most commonly prescribed treatment options:

  • Keratolytics: emollients that contain lactic acid, glycolic acid, salicylic acid or urea that help soften and flatten the keratin plugs and are the first line therapy for KP. The bumps will stay flat as long as treatment is continued, which can be in the form of lotion, cream, ointment, or cleanser.

  • Retinoids: tretinoin, adapalene, tazarotene creams are second line treatment for patients who fail the first line treatment. These help shed the overgrown keratin plug and keep the skin smooth. Systemic retinoids can be used as third-line treatment option if above fail.

  • Topical steroids: steroids are used for treatment and control of inflammation for a short period of time. 

  • Lasers: Combination treatments with lasers like 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. 

  • Microdermabrasion: This 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 the area of active inflammation can cause discoloration and even scarring. 

It is important to talk to your dermatologist for evaluation of your skin and symptoms so a customized treatment plan can be prescribed for you.