Keratosis Pilaris: causes, symptoms, diagnosis and treatment

Keratosis pilaris is a very common skin condition characterized by the appearance of tiny, hard, whitish or red colored bumps on the skin. The other name for this condition is “chicken skin’ because of its resemblance to the rough bumps on the chicken’s skin. These tiny bumps tend to appear on the upper arms, thighs, back and buttock. They are less commonly seen on the forearms, upper back and face.

Keratosis pilaris affects every other individual once in a life time. This skin condition first appears in the childhood and reaches to its maximum in adolescence, especially around the puberty.

The condition begins to improve with the age of the person and usually disappears after the age of 30. Thus, keratosis pilaris is the condition of adolescents and is rarely seen in adults. 50-80 percent adolescents are affected by this skin disorder. However, in adults the incidence rate is 40 percent.

There is nothing to be afraid of keratosis pilaris as it is a completely benign condition that does not cause any harm to the affected person. For those who think that it is a contagious condition, it is a myth because keratosis pilaris cannot be transferred from one person to another through contact.

Usually, this condition is asymptomatic and does not need to be treated unless the bumps become inflamed or itchy. Keratosis pilaris seems to be a harmless condition, but the people consider it a stigma to personality having those tiny bumps on the body that look ugly and weird. So, keratosis pilaris can also be treated for cosmetic reasons as well.

Otherwise, the treatment would not be required as long as the condition remains asymptomatic because it is a self limiting condition that regresses on its own by the age of the individual.

Keratosis pilaris has the following types or variants:

• Keratosis pilaris alba (rough bumps appear on the skin, but there is no irritation)
• Keratosis pilaris rubra (reddish inflamed bumps appear on the skin)
• Keratosis pilaris rubra faceii (appearance of reddish bumps on face)

How does Keratosis Pilaris look like?

The skin conditions sometimes look so alike that it becomes frustrating, even for the doctor, to differentiate between them. Same is the case with keratosis pilaris. This skin condition may be confused with other similar conditions of skin like eczema, atopic dermatitis and above all acne. But keratosis pilaris has its own distinct features that can help you in differentiating it from other skin conditions.

Figure 1: Keratosis Pilaris - spiky bumps on arm
Picture credit: http://www.flickr.com/photos/40949904@N00/445798906/ keratosis_pilaris

Here are given the most prominent features and symptoms of keratosis pilaris:

• Small, hard and spiky bumps about the size of sand grains appear in patches on upper arms, thighs and buttocks.
• Bumps are usually skin colored but they can give reddish appearance on becoming inflamed. Unlike acne pustules, the keratosis pilaris bumps are just about the size of 1-2mm.
• Typical chicken skin or goose bumps appearance of skin is a strong indication of keratosis pilaris.
• On touching the affected skin, it feels like sandpaper.
• Skin becomes dry and rough. Dry weather and winter season tends to worsen the condition.
• The bumps are usually painless but they can become itchy and painful when the skin gets too dry.
• Keratosis pilaris on the face gives a flushed appearance to the skin of face.
• The affected skin may undergo discoloration or doubling of skin tone.

What are the causes of keratosis pilaris?

Understanding the cause of disease is equally important as treating it. Once you know the reasons behind the onset of a certain disease or the factors that can aggravate the disease, you may be at least able to avoid those initiating or triggering factors. Unfortunately, the keratosis pilaris is one of the least studied skin condition. The mechanism of initiation of this skin condition is not well understood.

The exact cause behind the onset of keratosis pilaris is still unknown and is still under debate.

However, few factors were figured that somehow may be involved in initiating and triggering keratosis pilaris are:

Genetics

All is written in your genes. The way you look, the way you behave and the way you think, all information regarding your personality is stored within your genes. The traits or characteristics that you inherit from your parents depend on the genes you carry from them. From the color of your eyes to the structure of the minute pore in your skin, everything is decided by your genes. As long your genes are working fine, your body systems will remain in order.

But even when a single gene structure gets mutated or altered, it can disturb the normal functioning of several systems in the body. The same thing happens in keratosis pilaris. In this skin disorder the mutation occurs in one of the genes regulating the proliferation of skin cells and skin proteins. Keratosis pilaris is an autosomal dominant disorder that means if one of the parents is affected with this disorder, the chances of their child having it would be 50%.

Thus, keratosis pilaris is an inherited disorder that can be passed on from one generation to another. Hence, having a family history of keratosis pilaris may increase your likelihood of getting this disorder.

But the question still remains there that how the mutation in a gene can lead to keratosis pilaris?

The answer to the query will be easy to understand if you have the hint about the normal functioning of skin. Our skin cells produce a hard natural protein called keratin. The purpose of this keratin layer of skin is to provide protection against infection and other harmful materials.

Keratosis pilaris is a disorder of hyperkeratinization in which the production of keratin protein by skin cells goes beyond normal. The skin contains millions of hair follicles. The excessive keratin produced begins to accumulate in these hair follicles, plugging their pores.

Normally, the dead cells of hair follicles shed off with time and are replaced with new ones. But when keratin plugs the pores of hair follicles, it prevents the dead skin cells from sloughing off and escaping through those pores. The accumulation of the keratin within the hair follicles makes the dead cells more cohesive.

Thus, the buildup of excess keratin along with dead skin cells in the hair follicles leads to the formation of raised bumps on the skin. So, the bumps of keratosis pilaris that you see on the skin are nothing else but the blocked hair follicles, plugged with keratin and dead skin cells. That is why keratosis pilaris gives the typical goose bump appearance of skin.

Genetic factors seem to be a potential cause of keratosis pilaris, but there are some other factors under consideration that may trigger the outbreak of keratosis pilaris.

These factors include:

Skin allergies and skin disorders

Keratosis pilaris is associated with many other similar skin conditions like itchiyosis vulgaris, eczema and atopic dermatitis. Keratosis pilaris was found to be aggravated in people having allergic skin disorders.

In such cases, curing the underlying skin condition can help in the regression of the outbreaks of keratosis pilaris. Attack of asthma and allergic rhinitis can also exacerbate the outbreaks of keratosis pilatis in genetically predisposed individuals.

Keratosis pilaris can also be really troublesome in dry and winter weather when the skin loses its moisture and become extremely rough and itchy.

Hormonal imbalances

Although kertosis pilaris can affect both men and women, yet females are more likely to suffer from this condition. The reason behind this high likelihood in females is the hormonal imbalances. Women having hormonal disturbance or estrogen dominance have more chances of getting keratosis pilaris.

That is why many women complain of keratosis pilaris around the time of pregnancy, when the hormonal changes take place in the body.

Vitamin A deficiency

Vitamin A plays a vital role in keeping the skin healthy and beautiful. It helps in the regulation of proliferation of the skin cells. Vitamin A has a potency to limit the process of keratinization of skin. It prevents the skin cells from undergoing hyperkeratinization. The deficiency of this crucial vitamin can cause the skin to become scaly, dry and hyperkeratinized. Therefore vitamin A deficiency is not the direct cause of keratosis pilaris but it can aggravate the condition indirectly.

Gluten allergy

Gluten is a wheat protein. People having celiac disease or leaky gut syndrome suffer from gluten intolerance, which means whenever they eat wheat, their body becomes hypersensitive to the gluten component and the allergic reaction is evoked in their body. Research studies were conducted to establish the link between gluten allergy and keratosis pilaris. It was seen that gluten allergy does have a certain role in aggravating the symptoms of keratosis pilaris. Thus, people having gluten allergy are more prone to have keratosis pilaris outbreaks.

Yeast infection

Yeast infection on the skin also increases the risk of flaring up keratsis pilaris. It is believed that yeast infection increases the skin cell turnover rate that promotes hyperkeratinization. So, ones having yeast infection may get an aggravated outbreak of keratosis pilaris.

How to diagnose the keratosis pilaris?

Since keratosis pilaris is a harmless condition with no troublesome symptoms, the affected patients usually don’t come to the doctor for consultation unless they have cosmetic issues. A few bumps on arms or thighs would be fine for the sufferer because he may not notice them.

But when keratosis pilaris appears on the face or the symptoms get worse, it may start bothering the affected person. Laboratory tests are not needed for diagnosing keratosis pilaris. The diagnosis is made on the basis of clinical presentation and symptoms of the patient.

The doctor will ask the patient some questions about the history of disease like:

• When did you first notice the symptoms?
• What aggravates or relieves the symptoms?
• Does any other family member have the same condition?

These questions will help the physician in making a wild guess about the diagnosis. After talking about the symptoms, the doctor will do the physical examination of the affected areas.

The typical symptoms of keratosis pilaris like goose bumps appearance, raised bumps on the skin with ingrown hair and rough texture of the skin will help him out in making a final diagnosis.

Skin biopsy is taken very rarely, only when the condition is widespread or when there is a lot of confusion between similar skin conditions.

How to cure keratosis pilaris naturally?

Keratosis pilaris is a genetic disorder. There is no way to permanently cure it, but at least you can try some remedies that help in keeping this condition under control.

Natural remedies are the best and the cheapest way to manage keratosis pilaris at home.

These remedies won’t cost you much, but they will help a lot in improving the symptoms.

Be gentle with your skin

Skin is the most exposed organ of the body. The skin has to face all the odds and seasonal variations. Everyone dreams of having a glowing, beautiful and smooth skin. This can be made possible only if you take proper care of your skin.

Always be gentle with your skin. Never do unnecessary experiments with skin as it can aggravate your problem of keratosis pilaris. The first thing you can do to get rid of those ugly looking bums is to exfoliate them. Gently scrub the affected area with a pumice stone while taking bath. After taking the shower, gently pat the skin dry with a towel.

Avoid rubbing or scrubbing the skin too hard as it can damage the skin and can aggravate the problem.

Moisturize the skin

Taking care of skin is all you need to do to get rid of keratosis pilaris. May be you can’t heal it completely, but you can at least try your best to keep this problem at bay. Keratosis pilaris symptoms get worse when the skin gets dry and loses its moisture. Try to retain moisture in your skin as much as possible.

Moisturizing the skin will be effective in reducing the appearance of bumps visibly. So whenever, you take a shower or feel like your skin is getting dry, just pick any moistening lotion or cream and moisturize your skin with it.

Lotions containing glycolic acids or alpha hydroxy acids are preferred because alpha hydroxy acids are excellent exfoliators. They remove the superficial dead cells and rejuvenate the underlying skin, giving a fresh and healthy look to your skin. There is no harm in moisturizing the skin.

You can safely do it 2-3 times per day or as per your need. If you are having keratosis pilaris associated with eczema or atopic dermatitis, applying zinc oxide containing lotion or creams help out in reducing inflammation associated with bumps or rashes.

Choose products wisely

The only cure of keratosis pilaris is to keep the skin moisturized. Never use harsh soaps to wash the skin because the ingredients in soaps can suck the moisture out of skin, making it dry, itchy and rough. So if you are facing the problem of keratosis pilaris, ditch the harsh chemical containing soaps and go for the mild soaps containing moisturizing agents that prevent the skin from getting dry and rough.

Make friends with yogurt

Yogurt is considered to be one of the best antidotes for keratosis pilaris. Look how simple it is to get a clear skin by using yogurt. It sounds gross at first, but yogurt can help you get the skin that you always dreamt of. It’s actually the ingredients in yogurt that will help in clearing away those hideous bumps on your body. Yogurt contains a natural exfoliator called lactic acid.

Lactic acid has the property to dissolve excessive keratin buildup, leaving the skin soft and subtle. Applying yogurt to the affected skin area daily for 15-20 minutes will help you through in fighting the monster of keratosis pilaris.

Use apple cider vinegar

Like yogurt, apple cider vinegar is an excellent exfoliator. Mix one part of apple cider vinegar with one part of water. Apply it to the affected area and leave for a few minutes. Apple cider vinegar helps to give a smooth texture to the skin by cleansing the excess keratin deposits.

Avoid hot shower

Taking hot showers is not recommended for you if you are facing the trouble of keratosis pilaris. Hot showers can worsen keratosis pilaris by making the dry and rough. So, avoid taking hot shower and go for the bath with lukewarm water. Having a bath with lukewarm water will work fine for you.

Coconut sugar scrub

Coconut oil is considered to be an excellent and effective home remedy for keratosis pilaris. Its magical properties tend to moisturize the skin deeply while its healthy nutrients help in rejuvenating the skin from within.

There is no need to buy expensive exfoliating creams or scrubs because now you can make your own scrub at home very easily. Coconut oil, honey, granulated sugar and brown sugar are all you need to make a scrub at home.

Mix 1 tablespoon of brown sugar, 1 tablespoon of granulated sugar and 1 tablespoon of honey with 2 tablespoons of virgin coconut oil.

Mix all the ingredients well till a paste is formed. Now apply this paste to the affected area and rub it gently to exfoliate the dead skin cells. The sugar components of skin will peel away the dead cells while the honey and coconut oil will smooth out the skin by moisturizing it. Gently exfoliating the skin for 10-15min with scrub will give a smooth texture to the skin.

Eat a healthy diet

Go green. Eat fresh and leafy vegetables. Green leafy vegetables are an excellent source of vitamins and minerals like vitamin A, B, E and C, all necessary for keeping the skin healthy and problem free. Avoid gluten and milk products if you think you are allergic to them and consuming them is giving you a tough time with keratosis pilaris.

Consume foods containing plenty of Omega-3 fatty such as salmon, flaxseeds, walnuts, beans and legumes.

All these healthy nutrients play a vital role in regulating the proliferation of skin layers and in removing the dead skin cells as well. And also don’t forget to drink 8-10 glasses of water because it is necessary to keep your body well hydrated in order to control the keratosis pilaris outbreak.

Do yoga

Studies suggest that skin condition like eczema and keratosis pilaris get worse with stress and anxiety. So keeping this in mind, it is recommended that you do exercise or yoga to keep the stress away. Yoga helps in relieving anxiety and in improving the skin condition.

Medical treatment for keratosis pilaris

If everything fails to improve the symptoms of keratosis pilaris or you think the ugly bumps look cosmetically unpleasant, then it’s better to consult a skin specialist.

The medical treatment for keratosis pilaris may be done following ways:

Topical exfoliators

The purpose of exfoliating agent is to remove the dead skin cells and keratin. Your doctor may prescribe you medicated exfoliators containing one of the topical exfoliating agents like salicylic acid, lactic acid or alpha hydroxyl acid.

Topical retinoid creams

Along with topical exfoliators, skin specialists usually prescribe the topical retinoid cream containing retinoids like tretinoin, tazarotene or adaplene. Retinoids are the derivatives of vitamin A. These retinoids act like keratolytic agents. When applied to the affected area, they break up or dissolve the hard keratin buildup and control the skin cell proliferation.

Microdermabrasion

Microdermabrasion procedure is done for cosmetic purposes. In this treatment, the superficial dead skin cell layers are peeled away with a help of a small machine or abrasion tool. The abrasion machine is fixed with fine crystals of aluminium oxide or diamonds. These fine crystals take away the keratin and dead skin cells away when the skin is massaged with microdermabrasion machine.

Laser therapy

If you are just sick of these unsightly and ugly looking reddish bumps and want to get rid of them at any cost, laser treatment can help you then. Ingrown hair in the bumps can cause their inflammation. Laser therapy is one of the best ways to make the bumps and redness less visible. In laser treatment, the intense light beams are targeted to the affected area. These light beams resurface the skin by removing the top layer of dead skin cells.

When the dead skin layer is removed, the new skin cells appear from beneath, giving a fresh and healthier look to skin. Apart from resurfacing the skin, the laser light can also help in removing the ingrown hair from the bumps, making the appearance of keratosis pilaris less noticeable.