Keratosis Pilaris

Have you ever wondered how to get rid of those tiny bumps on the back of your upper arms? Their medical term is keratosis pilaris. Let’s look at what causes this common benign skin condition and how to treat it.

Keratosis pilaris causes

These rough patches of skin with tiny bumps can develop on your upper outer arms, cheeks, thighs or buttocks. They feel a bit like sandpaper. They are not painful or itchy.

Keratosis pilaris is a condition where hair follicle openings get plugged with keratin.




Although we know keratin overproduction and plugging is involved, dermatologists don’t really know why these hair follicles plug up. One clue is that fact that keratosis pilaris is often found in persons with dry skin, seasonal hay fever, rhinitis, asthma, eczema, or atopic dermatitis. These skin conditions are a result of immune hypersensitivity to something in a person’s environment.

Therefore, underlying causes of keratosis pilaris can include:

· Subtle allergy to a food or chemical. This triggers inflammation to manifest on vulnerable skin areas

· Stressful emotions that release stress chemicals of inflammation (e.g. inflammatory cytokines)

· Dry skin from personal hygiene products

· A genetic predisposition

· Friction from tight clothes

Treatment

There are some first steps that can reduce the severity of keratosis pilaris:

· Limit bath/shower time and lower water temperature to reduce skin oil loss

· Use moisturizing soap or moisturizing ointment. I personally use and recommend Dr. Christopher’s Complete Tissue and Bone Ointment (only natural ingredients) immediately after bathing; you can purchase this online for less than $15. Also, lanolin, petrolatum, glycerin, and combination products such as Eucerin and Cetaphil can moisturize if applied several times daily. Other products could include cocoa butter, shea butter, and coconut oil.

· Use a humidifier, although it may not be practical to highly humidify your home.

· Reduce friction or tight clothing to the affected area; this could be a cause

In most cases simple moisturizing creams will have a very limited effect but are helpful to maintain a healed skin state. You’ll probably need to remove the dead cells (exfoliate) from the affected skin area. Exfoliation helps get rid of the small keratin plugs of keratosis pilaris.

Medicated creams that exfoliate skin contain urea, lactic acid, alpha hydroxy acid, or salicylic acid. These are purchased over-the-counter or by prescription.

Most effective prescription topicals are from a few different ingredient categories. Let’s look at these.

Vitamin A creams (topical retinoids) promote cell turnover and prevent plugging of hair follicles:

· Tretinoin (e.g. Retin-A) inhibits microcomedo formation and eliminates the lesions present. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. Tretinoin topical is available as 0.025%, 0.05%, and 0.1% creams and 0.01%, 0.025%, 0.04%, and 0.1% gels.

· Tazarotene (e.g. Tazorac) is a synthetic retinoid drug with less skin irritation than Tretinoin. Its active metabolite stimulates differentiation and proliferation of epithelial skin with anti-inflammatory properties

Adapalene (Differin)

Adapalene acts on retinoid receptors. It treats acne by its effect on cellular differentiation, keratin formation and inflammation. It normalizes the formation of follicular epithelial cells to comedone formation. Comedones are small acne bumps; blackheads are open comedones, while whiteheads are closed comedones (the follicle is completely blocked). Adapalene is often tolerated by those who cannot tolerate tretinoin creams. Expect a therapeutic response after 8-12 weeks of therapy.

Alpha hydroxy acid is a normal constituent of tissues and blood. Alpha hydroxy acids such as Lac-Hydrin act as humectants (to moisturize) and break down keratin plugging when applied topically. Use the 12% cream or lotion.

Urea promotes hydration and removal of excess keratin of hyperkeratosis. It is available in 10-40% concentrations. Topically applied urea increases water retention in skin and decreases itching.

Corticosteroid creams range in potency more than 1,000-fold from hydrocortisone 1% (over-the-counter) to betamethasone 0.05% or clobetasol 0.05%.[1] These have profound anti-inflammatory and vasoconstrictive properties. The way to make steroid cream/ointment super potent is to cover the area with plastic (sandwich) wrap for an hour or more to drive the medicine much more fully into your skin.

Remember that high potency topical steroids should not be used longer than three weeks to prevent tolerance (it stops working) and tachyphylaxis (your symptoms rebound worse after you stop). Use the pulse-dose method to circumvent that problem: stop using it after 1-2 weeks to avoid rebound symptoms; allow for a steroid-free period of at least a week.

Once steroid cream has dramatically improved the irritated skin, then use a urea and salicylic acid cream to maintain it.

Topical immunomodulators such as tacrolimus (Elidel) or pimecrolimus (Protopic) are also effective in treating keratosis pilaris.

Procedures

If creams aren’t effective for keratosis pilaris, in office procedures can be done. These include:

  • Dermabrasion or microdermabrasion

  • Chemical peels

  • IPL (intense pulsed light) or laser light therapy

  • Blue light therapy (less effective)

  • Surgical extraction of trapped hairs or keratin plugs

To aging beautifully and feeling good,

Michael Cutler, M.D.


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[1] https://www.aafp.org/afp/2009/0115/p135.pdf

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