Keratosis pilaris is so named because it produces hard ‘keratotic’ bumps related to hair follicles. Keratin is the protein that provides structural support and toughness to the skin. It is a very common condition which affects 40-50% of adults and 50-80% adolescents. Most people who have the milder variety of Keratosis pilaris may not even realize they have the condition. Resemblance to the spiny chicken skin gives it the name the chicken skin disease.
Causes of Keratosis Pilaris
In keratosis pilaris, keratin accumulates forming hard plugs which blocks the opening of the hair follicles. Why and how the keratin accumulation occurs is not clear. This type of keratin accumulation is common in extremely dry skin conditions seen in icthyosis vulgaris and atopic dermatitis. Keratosis pilaris is also associated with many genetic diseases where dry skin is a prominent feature.
Keratosis pilaris is sometimes seen in healthy individuals as well.
Clinical Features of Keratosis Pilaris
Keratosis pilaris presents as minute, grouped, acne like bumps; grey to brown in color. In some, the rashes are inflamed, red and itchy. Usually, however, itching is not a prominent feature in keratosis pilaris, though a warm discomfort is felt over the affected skin.
The common sites involved are upper arms, shoulder, back, thighs, buttocks and legs. Rarely keratosis pilaris appears on the face, where it resembles blackheads.
On the shoulder and back at times there are islands of spiny bumps with areas of rough, dry skin in between.
Keratosis pilaris is more prominent during winter, and improves in summer. It usually starts at the age of 3-5 years, continues till 20 years of age and then gradually subsides. There are many variants of keratosis pilaris, from mild to moderate and from grey to red. When the spiny rashes are red, this is known as keratosis pilaris rubra.
Treatment of Keratosis Pilaris
Treatment of keratosis pilaris involves general care of the skin and specific care. The aim of the treatment is to moisturize the involved skin and make the keratotic plugs soft so that they can be removed with exfoliating creams.
- A balanced diet, with regular helpings of fresh vegetables and fruits is essential in the management of any skin disease, especially so in diseases involving disorders of the keratin protein.
- Some reports indicate intake of vitamin A, essential fatty acids and omega 3 oils helps in improving the dryness of the skin and reducing the keratin plugs in keratosis pilaris.
- Humidifying the living room and bed room during winter improves both dry skin and keratosis pilaris.
- A moisturizer containing urea 10-20%, lactic acid etc are applied and rubbed in to the involved skin soon after bath in the morning. A gentle cleanser should be used before applying the moisturizer.
- During night, keratin removing creams (called keratolytics) containing 2-3 % salicylic acid , 10-20 % glycolic acid, 10-15% AHAs, retinoids like tretinoin 0.05% , adapalene 0.1%, or tazarotene 0.1% are applied. These creams may cause irritation, hence should be used carefully.
- Special polymer type coating containing salicylic acid which forms a thin film over the skin has been found to be effective in keratosis pilaris.
- Photo pneumatic therapy which combines pneumatic energy and broad band light has been reported to be effective in some cases of keratosis pilaris rubra.
- Topical steroids of mild to moderate strength can be used for shorter periods if the involved skin is irritated.
- Tacrolimus, an immunomodulator, is helpful in resistant cases to reduce the cell turn over which causes the formation of keratin plug in keratosis pilaris.
Keratosis Pilaris : What to Expect after Treatment
Regular treatment of keratosis pilaris will get rid of the horny plugs and improves your skin texture and appearance, but, recurrence is the norm if treatment is stopped. Keratosis pilaris tends to persist for years, before disappearing spontaneously.
Reference
Various Text Books and Journals of Dermatology
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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