The scoop about chicken skin! (keratosis pilaris)

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!

Keratosis pilaris on the outer arm;
Keratosis pilaris on the outer lateral leg;

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.

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