What Is Keratosis Pilaris

Keratosis Pilaris is a common skin condition, especially in young adolescents, which  an adult  can also be affected. It is not life-threatening and symptoms are easily manageable with the correct medical intervention. Although no treatment is known for the full immediate recovery of the patient, there are many procedures like  laser therapies and medicated creams (containing specific chemical substances  like retinoids)  to manage the symptoms.

Keratosis Pilaris,  or chicken or strawberry skin, is a skin condition that appears as bumps  caused by blockage in the hair follicles due to excess keratin build-up.

There is no known determined cause of Keratosis Pilaris. However, it is thought to some extent to be a genetically inherited disorder. Certain risks   can contribute to the development of the disease.  

Overview

Keratosis Pilaris (KP) is a common dermatological condition characterised by chicken-like skin appearance. It has a higher incidence in adolescents of 50-80% (puberty). Although, it can also affect adults 40%.¹ 

Major signs are dry, rough, and bumpy skin due to the buildup of keratin in the hair shaft (the visible portion of hair outside the skin), accompanied by some degree of erythema (redness of the skin). 

Keratin is a protein found in the structure of the nails, epidermis (outermost layer of the skin), and hair. Generally, the condition either improves or does not change with age, although there are rare cases when it can  worsen. A report suggested that during the hot season, this condition tends to get better  whereas in winter, symptoms would heighten and get worse.²   

What factor causes keratosis pilaris?

The specific cause of Keratosis Pilaris is not known. KP  is a non-infectious skin disorder.  Therefore, it cannot contaminate other people via physical contact. KP was believed to be an  inheritance factor  and referred to as  autosomal dominant disorder; the chromosomes were 22, excluding the sex-linked chromosome 23.

A triggers diseases without 23 pairs of chromosomes; giving a total of 46. Also, as the condition is considered dominant, one of the biological parents has to have KP traits  (approximately 39% of patients have a family history of KP).³ 

The mutation, at some point, led to a  hair shaft defect or an incorrect keratinisation , forming a keratinous plug, causing a blockage at the opening of the hair follicle.

Certain health condition are associated with the development of Keratosis Pilaris:⁴

• Genetic predisposition (family history)
• Atopy ( when a patient is more likely to develop an allergy response due to a compromised immune system)
• Ichthyosis vulgaris (a skin condition characterized by skin cells build, causing a fish scale-like skin appearance)
• Scarring alopecia
• Cardiofaciocutaneous syndrome (CFC) 
• Eczema (atopic dermatitis)

What are the signs and symptoms to look for in keratosis pilaris?

Most people suffering from Keratosis Pilaris are asymptomatic. However, those who do experience symptoms of Keratosis Pilaris, have clinical signs linked to the physical appearance of the skin:

• Dry skin
• Rough, bumpy skin appearance 
• Goosebumps- like skin appearance
• Chicken skin appearance
• Gooseflesh resemblance to the skin

Such chicken skin-like appearance is mainly observed at specific parts of the body such as:¹

• Upper arms-92%
• Thighs- 59%  
• Buttocks- 30%
• Potentially face and trunk 

Management and treatment for keratosis pilaris

There is no known cure for Keratosis Pilaris since the condition can dissipate when a person gets older (usually around 30 years). 

However, there are many medical options for the improvement and management of symptoms,mainly related to cosmetically displeasing concerns, that can result in distress and psychological damage:⁵

• Laser treatments
• Keratolytics (substances that soften the skin and break down the built-up keratin)
• Vitamin D3 analogues
• Topical and systemic retinoids
• Use of emollients ( moisturising treatment preventing skin dryness)

There are also medicated creams available (for self-treatment) over the counter at weaker concentrations, containing ingredients:

• Glycolic acid
• Alpha hydroxy acid (AHAs)
• Salicylic acid- e.g.6% salicylic acid lotion

In more severe cases a dermatologist prescription can be given for stronger keratolytic such as:

• Urea- 20% urea cream lotion
• Retinoids (vitamin A derivatives) -e.g. 0.01% tazarotene

 Most treatment options aim to keep the skin hydrated and well moiturised ; gently exfoliate the skin, and break down/remove any keratin buildup at the hair follicle. 

How to get diagnosed ?

A diagnosis is an examination to analyse  physical skin appearance. The use of a dermoscopy provides information about abnormalities in the hair follicle. The  family’s history is taken into account. ⁶

FAQs

How can I prevent keratosis pilaris?

Prevention may not be possible if the condition is inherited. Yet, we need  to make sure that  the skin is well hydrated to ameliorate KP , especially during the drier and colder months (e.g. winter).

Some additional things that can be done are:

• DO NOT take long hot baths
• DO NOT exfoliate your skin too often
• DO NOT do harsh scrubbing
• DO NOT use skin products with fragrances, that can irritate the skin( eg. perfumed soaps)

How common is keratosis pilaris?

Keratosis Pilaris is a common skin condition, especially in adolescents ~50-70% and  can be diagnosed in adults ~40%. Around 39% of patients have a family history of KP.

Who is at risk of keratosis pilaris

The main predisposing factors for Keratosis Pilaris :

• Family history of Keratosis Pilaris 
• Ichthyosis vulgaris
• Dry skin
• Eczema ( atopic dermatitis)

When should I see a doctor?

Although the condition is not harmless, it can cause distress or a feeling of confidence to the patient due to its cosmetic appearance. Also, if the skin feels painful and itches. A dermatologist should diagnose and prescribe the appropriate treatment options for managing the symptoms. 

Summary

Although the condition is not harmless, it can cause distress or a feeling of confidence to the patient due to its cosmetic appearance. Also, if the skin feels painful and itches. A dermatologist should diagnose and prescribe the appropriate treatment options for managing the symptoms. 

Keratosis Pilaris is a common skin condition, usually affecting adolescents, and is characterised by the build-up of excess keratin around the hair shaft, giving a chicken skin-like appearance. It is not medically harmful to the patient,]. However, depending on the severity, it can be cosmetically displeasing. In most cases, Keratosis Pilaris can dissipate with age or remain constant without worsening the condition. 

However, there are many treatment options to manage the symptoms, both over-the-counter and doctor-prescribed. The common ones include medicated creams containing topical and systemic retinoids, urea, glycolic and salicylic acid, AHA, etc. Also, lifestyle adaptations can contribute towards better overall outcomes.