Ep 219 – Keratosis pilaris

Keratosis pilaris is a common and harmless condition that can, nevertheless, cause distress in some people due to its appearance. In this episode, Dr Kate Chesterman considers the pathophysiology and diagnostic features of keratosis pilaris, before discussing self-care advice and treatment options that can be recommended to try to reduce the rough, bumpy and dry appearance of this condition.

Key take-home points

• Keratosis pilaris is a common, harmless skin condition that causes bumpy, rough skin resembling “permanent goosebumps”.
• It often begins in childhood and affects 50–70% of teenagers and around 40% of adults.
• It is caused by keratinous plugging of hair follicles, leading to rough, dry bumps.
• It is more noticeable in winter due to dry skin and increased friction from clothing.
• It can be associated with atopic eczema, ichthyosis vulgaris, other atopic conditions, obesity, type 1 diabetes and Down's syndrome.
• Bumps may be skin-coloured, white, red, pinkish-purple or brownish-black depending on skin tone, and are commonly found on the upper arms and anterior thighs.
• Keratosis pilaris cannot be cured, but it often improves with age.
• Self-care measures include using mild, unperfumed soaps, gentle exfoliation, and cool showers or baths, and avoiding harsh scrubs, perfumed soaps, hot baths, scratching, and shaving or waxing.
• Regular emollients containing salicylic acid, lactic acid or urea can be used 2–3 times daily to soften the skin and reduce the bumpy appearance.
• Topical retinoids can be considered for resistant cases, although they may cause irritation.
• Short-term topical steroids could be prescribed for temporary reduction of redness but should not be used long term.

Key references

1. NHS. 2024. https://www.nhs.uk/conditions/keratosis-pilaris/.
2. British Association of Dermatologists. 2021. https://www.bad.org.uk/pils/keratosis-pilaris.
3. Primary Care Dermatology Society. 2024. https://www.pcds.org.uk/clinical-guidance/keratosis-pilaris.
4. Primary Care Dermatology Society. 2024. https://www.pcds.org.uk/clinical-guidance/ichthyosis.
5. British Skin Foundation. https://www.britishskinfoundation.org.uk/conditions/keratosis-pilaris.
6. American Academy of Dermatology. https://www.aad.org/public/diseases/a-z/keratosis-pilaris-overview.
7. DermNet. 2022. https://dermnetnz.org/topics/keratosis-pilaris.