What is this bumpy skin on my outer arms and legs? It might be something called keratosis pilaris. It can mimic acne, folliculitis, eczema… which makes it hard to figure out alone. Here’s how to tell the difference!
What is keratosis pilaris (KP)?
It’s a common, benign condition usually starting in kids and will continue into adulthood. It presents as little white, red, or brown dry skin bumps on the face, outer arms and legs, buttocks over all the little hair follicle openings on the skin. It is believed to be caused by a filaggrin 1 mutation (same genetic change that causes eczema and icthyosis vulgaris), which is why patients with KP tend to also have eczema and dry skin. This gene tends to be passed down in families so genetic plays a key role in causing KP.
Is there a cure?
As it is a change in your genetics, there is no cure, yet… but it can be treated with lots of topical treatments to soften the bumps and make it less noticeable. Dermatologists will recommend keratolytic agents (meaning topical medications that break up the top layer of the skin called keratin) to soften the bumps. When the bumps are active, use of these keratolytic agents will make the skin smoother. However, as it is a chronic condition, stopping treatment will result in it coming back.
What are the treatments for KP?
- Over the counter options:
- Use of gentle cleansers – ie. Vanicream bar soap.
- Daily use of keratolytic agents during flare ups
- Daily use of moisturizers to calm down dry skin
- Ceramides (Cerave SA cream)
- Any good moisturizer (Vaseline, Aquaphor, Vanicream moisturizing cream, Cerave moisturizing cream, Cetaphil moisturizing cream)
- Gentle pumice stone or exfoliating scrub in the bath/shower
- Prescription options:
- Vitamin A topicals like retinol, retinoids – ie. tretinoin cream (may be used on face, arms, legs) in varying strengths/potency for softening skin
- Urea 40% cream – to soften the scales
- Hydrocortisone, Triamcinolone, or other topical steroids – to improve symptoms of itch or redness
- Cosmetic options:
- Laser hair removal – more permanent treatment to remove hair
- Electrolysis – more permanent treatment to remove hair
- Intense pulse light laser or Pulse Dye Laser to remove redness from bumps, but not the bumps themselves
- Chemical peels – may remove redness and bumps; will have to keep doing for maintenance
In summary, there are numerous treatments for keratosis pilaris. Trial of over the counter options at home may help improve some of the bumps, but if they persist despite home therapies then there are prescription options that may be more helpful for you. Sometimes, it may take trial and error before the best treatment may be achieved. Talk to your dermatologist to formulate a plan designed just for you.
I am a board certified dermatologist at Cedars-Sinai in Los Angeles. I am a comprehensive dermatologist caring for families. I love seeing children and adults. My youngest patient was 0 days old and my oldest was 110 years old. I have had psoriasis since the age of 8 and considered an expert in psoriasis and psoriasis treatments. I have lectured locally and nationally and published numerous papers on other topics such as skin manifestations of eczema, hidradenitis suppurativa, systemic lupus erythematous, granuloma annulare, microbiome, skin cancers, and more. My expertise includes knowledge in managing complex skin diseases. I am experienced with surgical treatment of skin cancers, as well as non-surgical methods to treat skin cancer and precancerous lesions. I run a full medical, cosmetic, and surgical dermatology practice. I am experienced with the use of complex dermatologic therapy, including biologic therapy, immunosuppressive medications, and phototherapy. I also treats fine lines and wrinkles non-surgically with combinations of botox, fillers, chemical peels, lasers, and radiofrequency. I perform minor surgeries such as excisions for cysts, lipomas, basal cell skin cancer, squamous cell skin cancers, and early stage melanoma. I am physician expert for Kopa for Psoriasis, part of Happify. I have been featured on podcasts and quoted in numerous online and print publications. I am honored to be named “Top Doctor” in Los Angeles magazine. In my free time, I volunteer for community events such as skin cancer screenings and at the local free clinics. I also teach internal medicine and dermatology residents at several academic centers. I try to do yoga every day and every year, I run a half-marathon at the Golden Gate Bridge.