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Keratosis Pilaris: The Little Red Bumps that Could

Posted Jul 08 2010 7:23am

Could be making you miserable, that is.  According to Dr. Nili Alai, M.D. FAAD , keratosis pilaris affects up to 40% of the adult population and 50-80% of adolescents worldwide.  Often confused with small goosebumps or acne, keratosis pilaris occurs when a skin-based protein [keratin] forms hard plugs within hair follicles.  The result are skin-colored bumps about the size of a grain of sand, along with a fine, bumpy texture.  Some cases are accompanied by erythema, or redness, to the skin.

Keratosis pilaris is found most commonly on the back and outer sides of the upper arms (though the lower arms can also be affected).  It is also commonly found on the thighs, hands, and the tops of the legs, flanks, buttocks, and face, where it is commonly mistaken for acne (especially in adolescents).

One telltale sign of KP is that the condition traditionally gets worse in the winter .  Another clue is that patients with KP often have been previously diagnosed with atopic dermatitis or ichytosis, as noted in the British Journal of Dermatology .

Although it is widely believed that KP decreases with age, this is not necessarily the case; as noted in a 2006 study amongst 83 patients over the course of 20 years, KP improved with age in 35% of patients, remained unchanged in 43%, and worsened in 22%.


There are numerous types of KP.  Helpful pictures of each are available here , through GoogleHealth .

  • Keratosis pilaris rubra (red, inflamed bumps which can be on arms, head, legs)
  • Keratosis pilaris alba (rough, bumpy skin with no irritation)
  • Keratosis pilaris rubra faceii (reddish rash on the cheeks)

1.  First and foremost, visit a board-certified dermatologist, who will be able to properly diagnose the condition.  It is possible that keratosis pilaris may advance to a rare condition known as keratosis pilaris atrophicans in some genetically susceptible individuals, so it is important to be properly assessed by a physician.

2.  As recommended by your physician, use moisturizing lotions containing urea, lactic acid, glycolic acid, salicylic acid, tretinoin, or vitamin D.  Some over-the-counter options include:

  • AmLactin ($22.99, Amazon.com ), which contains an unprecedented 12% lactic acid.  Molecules of lactic acid are larger than glycolic acid, so it does not penetrate the skin as easily.  However, lactic acid has not been associated with the same increase in UV sensitivity as glycolic acid, as mentioned in a 2000 study in the Journal of the American Academy of Dermatology .  As such, lactic acid is a better choice for the warm summer months, or if you live in a sunny climate year-round.
  • NeoStrata AHA 15 Lotion ($35.00, Amazon.com ), which contains 15% glycolic acid.  The advantages to glycolic acid over lactic acid are that glycolic acid has a smaller molecular structure, allowing for it to penetrate the skin more easily, and that glycolic acid has anti-aging properties, advancing desquamation and thinning of the stratum corneum (the uppermost layer of the skin). By exfoliating the top layer of the skin, glycolic acid peels smooth the skin, quicken the rate of cell turnover (which is  reduced by up to 7% every ten years ),  decrease small wrinkles and  increase the fibroblast proliferation of collagen .  Again, however, given that glycolic acid sensitizes the skin to UV rays , it is highly recommended that Neostrata or any other treatment be used with sun protection, preferably in the form of UV protective clothing.
  • Glytone Keratosis Pilaris 3-Piece Kit ($53.35, Amazon.com ).  Is it necessary to have a special cleanser for KP?  No.  But it is nice to have a specially-designed kit (well, for some of us, anyway!), and this one, replete with high concentrations of glycolic acid, is as good as any at delivering the AHA all over the skin.
  • LacHydrin Five ($11.33, Amazon.com ), which contains 5% lactic acid.  The interesting thing about   LacHydrin Five is that it is touted for its buffering with ammonium hydroxide, a basic substance.  While this buffering makes the lotion more easily tolerated, it also increases the pH and hence alters the potency of lactic acid.  So I’m not sure I like this one as well, but I will say that it is a solid choice for those with easily irritated or sensitive skin types.

4.  Call your physician for a follow-up if the condition does not improve after 1-2 weeks of continuous use of the recommended over-the-counter treatment(s).

Keratosis pilaris is a common skin condition, and no one should have to suffer from it.  If you think you may have KP, talk to your dermatologist immediately.  Your skin will thank you for it!

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