If you have red, brown or flesh colored bumps on the back of your arms, back, face or legs it’s likely you have a condition known as ‘Keratosis Pilaris’.
It’s commonly referred to as “chicken skin” and can resemble tiny pimples, sometimes with a fine hair coming out of it.
It is believed to be caused by either an excess of keratin, which is a protein which helps provide structure to the skin, or a reduced ability to exfoliate keratin.
Keratin helps provide structure to the skin as well as waterproof it. Keratin also makes up our hair and nails. Unfortunately, for whatever reason, keratin in those with keratosis pilaris clogs pores, and can sometimes also trap hair inside follicles.
The condition is hereditary, so it’s likely one of your parents had it in their youth. The condition can also clear up on its own with age, and is generally worse during puberty. It is more uncommon in those in their 30s and 40s. Cold, dry conditions such as those found during Winter can also make the condition worse.
Keratosis pilaris can lead to hyperpigmentation on the skin, and in serious cases permanent scarring and discoloration of the skin. In this article I will be dealing with the more common form of keratosis pilaris – of bumpy skin most commonly on the back of the arms and other parts of the body. More serious conditions of keratosis pilaris, such as keratosis pilaris atrophicans are best treated by a dermatologist.
Exfoliating and Moisturizing
Treatment of keratosis pilaris involves exfoliation of the skin and then moisturization of the skin. Unfortunately no standard treatment is effective for all cases, though consistent treatment should reduce the amount of skin affected.
Methods of exfoliation usually involve salicylic acid, as it can dissolve in to sebum allowing it to enter pores and begin to remove the keratin plugs. Salicylic acid has also been combined with topical Vitamin A acid derivatives, such as retinoic acid. Retinoic acid helps the skin shed more evenly, and also thins the skin (due to increased cell turn-over). Success has varied, some people respond very well to the treatment, whereas others have no results at all.
It’s possible to use a higher percentage of salicylic acid on the body, around 5%. Unfortunately leave-on products are limited to 2% salicylic acid, but there are higher percentage salicylic acid products available online. There are also shampoos that contain 3% salicylic acid, such as Selsun Blue Naturals ($7.54 for for 11 oz on Amazon). If you do choose the Selsun Blue product, I would recommend letting it sit on the skin for 5 minutes before washing off, (It’s great for blackheads on the nose as well.)
Physically exfoliating the skin may benefit those suffering from mild keratosis pilaris, but it can also cause damage to the skin causing hyperpigmentation (brown and red marks) on the skin. If you do choose to physically exfoliate the skin, try to be gentle and take your time. Irritation to the skin will be reduced if you exfoliate lightly and for a longer time, than exfoliating with force for a shorter period. I would recommend using an exfoliating glove.
Keeping the skin moist and supple is also important, especially since the condition has been shown to worsen in the Winter. A popular product, that is commonly recommended for keratosis pilaris treatment, is AmLactin ($22.74 for 17.6 oz on Amazon), which has lactic acid. Since the lactic acid is neutralized, it won’t exfoliate the skin, but can help bind moisture.
One small study found good results after 4 weeks with the use of Aquaphor ($28 for 28 oz on Amazon). There’s nothing really special about Aquaphor, it’s a combination of mainly petrolatum (Vaseline), lanolin and mineral waxes – so one should see similar results with an effective moisturizer.
Anecdotally, people have also had good results with using coconut oil. Grape seed oil may work better though, as it is high in linoleic acid which is anti-inflammatory, and has been shown to lighten hyperpigmentation as well.
Apply the moisturizer of your choosing after a shower, when your skin is saturated with water, a study has shown that keratin is able to absorb more fatty acids (like linoleic acid) when it is wet.
There are also products that combine moisturizers with exfoliants, KP Duty by Dermadoctor ($36 for 4 oz on Amazon) is specifically designed for keratosis pilaris. It’s very expensive though for moisturizer with glycolic acid. There are much cheaper alternatives such as Alpha Hydrox AHA Enhanced Lotion ($8.49 for 6 oz on Amazon), just make sure the pH of the exfoliating lotion is below 5.5.
Corticosteroid creams have also been prescribed for the treatment of keratosis pilaris, though I personally believe this should be reserved for serious cases. Strong corticosteroids work by thinning the skin, but there are associated side effects and should be done under the supervision of a dermatologist.
Tanning and Covering It Up
There is anecdotal evidence that sun exposure helps keratosis pilaris. One person reported that a deep sunburn removed the keratosis pilaris completely, unfortunately it did eventually return.
I am absolutely not recommending tanning as a treatment for keratosis pilaris, but a darker skin tone will help to hide the keratosis pilaris.
A self-tanner can effectively conceal the keratosis pilaris for up to a week, depending on how often you exfoliate your skin. I personally like St. Moriz Tanning Mousse ($6.51 for 6.7 oz on Amazon). It’s also available in the UK and on eBay for around 3-5 dollars.
Be aware that treatments like salicylic acid will cause the self-tanner to come off quickly, and possibly in patches, so I would suggest saving the self-tanner for special occasions or situations where you may be self conscious of your keratosis pilaris.
There are also other products which provide color to the skin temporarily, such as L’Oreal Paris Sublime Bronze One-Day Tint ($1.95 for 6.7 oz on Amazon) and MAC Face and Body foundation. This can come off on clothes though, especially if you sweat – so do keep that in mind.
There have been a few studies examining the role of Vitamin A and D in causing keratosis pilaris. The studies focus on more aggressive and scarring forms of keratosis pilaris, though – and the results weren’t strong.
One study using topical Vitamin D showed no results for keratosis pilaris, unfortunately.
There is anecdotal evidence that Omega-3 supplementation can help with keratosis pilaris, but I was unable to find any scientific studies that had examined this.
Laser and Experimental Treatments
A novel combination of ingredients known as “Fractional Prickle Coral Calcium” has been used successfully in Korean patients. Most patients saw about a 50% improvement in their skin after 5 treatments, two weeks apart. The ingredients were described as such “Niaciamide, arbutin, Rosmarinus officinalis, Chamomilla Recutita, Centella asiatica, kaolin, Lavandula Angustifolia, aloe vera, anti-bacterials, spirulina, allantoin, papain, mandelic acid, lactic acid, citric acid, salicylic acid.”
My assumption is that the niacinamide combined with the acids, particularly the salicylic acid are the components that are doing the brunt of the work. Luckily these two ingredients are cheaply and widely available.
Keratosis pilaris treatment has also been shown to respond well to laser treatment. Satisfactory results were achieved after 3 treatments. Keep in mind that laser treatment is very expensive, but I will link the studies: 1064-nm Nd:YAG laser, 1064-nm Nd:YAG laser, 1064-nm Nd:YAG laser, Combination laser with microdermabrasion.
The same study that looked at the effectiveness of Aquaphor also found 0.1% Tacrolimus ointment as effective. It’s possible that the Tacolimus ointment is more effective, but the study size was too small to be sure. Tacrolimus is an immuno-suppresant that is used in treating vitiligo and eczema.