Keratosis Pilaris

Keratosis pilaris is a common and harmless skin condition that affects millions of people worldwide, causing small, rough bumps that many describe as “chicken skin” or “gooseflesh.”

Table of contents

• What is Keratosis Pilaris?
• Medical Identification Codes
• Other Names
• Who Gets Keratosis Pilaris?
• What Causes This Condition?
• Signs and Symptoms
• Where Does It Appear?
• How is it Diagnosed?
• Treatment Options
• Self-Care and Home Management
• What to Expect Over Time

What is Keratosis Pilaris?

Keratosis pilaris is a very common skin condition that causes dry, rough patches and tiny bumps on the skin. The bumps usually appear on the upper arms, thighs, cheeks, or buttocks, though they can occur anywhere on the body that has hair follicles^[1]. The Latin term keratosis means “scaly skin,” and pilaris means “hair”^[6].

This condition is completely harmless and is not contagious or caused by an infection^[1]. The bumps are so common that many skin doctors consider keratosis pilaris a normal variation of skin rather than a medical problem. About 50% to 80% of teenagers and 40% of adults experience these bumps at some point in their lives^[2].

Medical Identification Codes

L85.3; L66.4

Other Names

KP, chicken skin, follicular keratosis, lichen pilaris, goose flesh

Who Gets Keratosis Pilaris?

Keratosis pilaris can occur at any age, but it is most common in young children and teenagers. The condition often appears in early childhood, becomes more extensive during the teenage years, and typically improves by age 30^[1][3].

You are more likely to develop keratosis pilaris if someone in your family has it, as the condition tends to run in families. Healthcare providers believe that certain genetic traits may cause it^[2]. The condition has an autosomal dominant mode of inheritance, which means if one parent has it, there is a chance their children will develop it too^[3].

Certain people are at higher risk for developing keratosis pilaris. You are more likely to have it if you have fair or light skin, certain skin conditions like eczema or ichthyosis vulgaris, asthma, hypothyroidism, Cushing’s syndrome, diabetes, Down syndrome, or obesity^[2][3].

What Causes This Condition?

The bumps you see with keratosis pilaris are caused by a buildup of keratin, a protein that helps form your hair, nails, and the outer layer of your skin^[2]. Normally, keratin flakes off naturally from the skin. In people with keratosis pilaris, excess keratin surrounds and blocks the hair follicles in the skin instead of exfoliating properly^[6].

When keratin clogs the pores where hairs come through the skin, it creates hard plugs that form small, raised bumps. This process is called hyperkeratinization^[2][9]. Research suggests that mutations in a gene that produces a protein called filaggrin may be associated with the condition. Filaggrin is a key protein that helps maintain the skin’s barrier function^[3][6].

Interestingly, many keratosis pilaris bumps contain an ingrown hair that has coiled inside the blocked follicle^[5][9]. Some researchers believe that these circular or coiled hair shafts may actually rupture the follicular lining, leading to inflammation and abnormal follicular keratinization^[5].

Signs and Symptoms

The main feature of keratosis pilaris is patches of tiny, rough bumps on the skin that look like permanent goosebumps or the dotted skin of a strawberry^[2]. The bumps are usually painless and typically the same color as your skin, though they may appear red, brown, or white depending on your skin tone^[2][6].

Most people with keratosis pilaris do not have symptoms beyond the appearance of the bumps. However, some people may experience itchy or dry skin, especially on the backs of the upper arms, legs, or buttocks. The skin where the bumps appear often feels rough, like sandpaper^[2].

The bumps often worsen when the air is drier, such as during the winter months. Seasonal changes that cause low humidity and dry skin can make the condition more noticeable^[1][6].

Where Does It Appear?

• Upper arms (most common location)
• Thighs
• Buttocks
• Cheeks
• Trunk
• Chest

The bumps most commonly appear on the outer sides of the upper arms and the tops of the thighs. However, keratosis pilaris can also occur on the buttocks, trunk, chest, face, and other parts of the body that have hair follicles^[6][9]. The condition does not appear on the palms of the hands or soles of the feet because these areas do not have hair follicles^[2].

How is it Diagnosed?

Keratosis pilaris is usually diagnosed by simply looking at the affected skin. Your healthcare provider will likely be able to identify the condition just by examining the bumps. No special testing is typically needed^[1][10].

If the diagnosis is unclear, your doctor may use a tool called a dermoscope, which is a special magnifying device that allows for a closer look at the skin. Dermoscopy can reveal abnormalities of the hair shafts, such as thin, short, coiled, or embedded hairs. Scaling and redness may also be visible^[6].

In rare cases where the diagnosis remains uncertain, your doctor might perform a small skin biopsy. This involves removing a tiny piece of skin to examine under a microscope. The biopsy typically shows thickening of the outer skin layer, plugged hair follicles, and mild inflammation^[6].

Treatment Options

There is no cure for keratosis pilaris, and treatment is usually not necessary since the condition is harmless^[1]. However, if you are concerned about how your skin looks, several treatment options can help improve its appearance.

The most common treatments involve medicated creams and lotions. Creams containing alpha hydroxy acid, lactic acid, salicylic acid, or urea help loosen and remove dead skin cells. These ingredients also moisturize and soften dry skin. These products are called topical exfoliants^[10]. Depending on their strength, they are available either with a prescription or over the counter.

Another option is creams derived from vitamin A, called topical retinoids. These work by promoting cell turnover and preventing plugged hair follicles. Examples include tretinoin and tazarotene^[10]. However, these products can irritate and dry the skin. If you are pregnant or nursing, your healthcare provider may suggest delaying retinoid therapy or choosing another treatment.

For redness and itching, short courses of moderate-potency topical corticosteroids (steroid creams) can provide relief^[6]. More advanced treatments include laser therapies, such as pulse dye laser treatment or intense pulsed light, which can help reduce redness. Laser-assisted hair removal may also help with ingrown hairs^[6].

It is important to know that using medicated cream regularly may improve how the skin looks, but if you stop treatment, the condition typically returns. Even with treatment, keratosis pilaris might last for years^[10].

Self-Care and Home Management

You can take several steps at home to help manage keratosis pilaris and improve the appearance of your skin. Keeping your skin moisturized is one of the most important things you can do. Use a gentle, non-fragranced, cream-based moisturizer daily^[16].

Gentle exfoliation can help remove dead skin cells and unclog follicles. You can use an exfoliating sponge or scrub in the shower or bath. However, avoid harsh physical scrubbing, as this can irritate the skin and make the condition worse^[6][16].

Other helpful self-care measures include avoiding harsh soaps and using soap-free body cleansers instead. Opt for warm water rather than hot water when bathing, as hot water can dry out the skin. Keep baths and showers short to prevent excessive drying^[16].

Do not pick at or scratch the bumps, as this can lead to irritation and possibly scarring. Wear loose, comfortable clothing made from soft fabrics. Avoid thick, tight, or abrasive clothing such as wool or spandex, as friction can worsen the bumps^[16].

Using a humidifier in your home, especially during dry winter months, can help add moisture to the air and prevent your skin from drying out^[16].

What to Expect Over Time

Keratosis pilaris is a long-term condition for many people, but there is good news: it usually improves on its own with age. The condition typically disappears or becomes much less noticeable by age 30^[1][6].

The condition does not cause any serious health problems. It does not hurt, and it does not lead to complications. However, it may make some people feel self-conscious or insecure about their appearance^[2].

While there is no permanent cure for keratosis pilaris, consistent care with moisturizers and other treatments can help improve how your skin looks and feels. Remember that this is a common condition that affects millions of people, and having it does not mean you have done anything wrong with your skin care routine.