Keratosis pilaris: all you need to know about chicken bumps!

Keratosis pilaris, also called KP for short, is a common skin finding in young children through young adults (50-80%) although it can occur at any age. It looks like “chicken skin” bumps. The small white, red or flesh colored bumps typically do not hurt but occasionally itch. The bumps can be surrounded by redness (rubra). See subtypes below. These very small bumps are usually located in groups scattered on the upper outer arms, thighs, cheeks (north) and cheeks (south-buttocks). Occasionally a small hair may be found coiled just beneath the bump. Females are affected more often than males. It is noted in all races. The bumps are formed by keratin (hard protein) that plugs the area near the hair follicles. It is not clear why the keratin builds up. While it is cosmetically displeasing, it is medically harmless and doesn’t necessarily require treatment. The rash typically resolves by age 30.

It is commonly associated with other skin conditions such as ichthyosis vulgaris, xerosis (dry skin), allergic eczema (atopic dermatitis), some genetic disorders and occurs in otherwise healthy people. It tends to worsen with dry skin and in the winter (low humidity). Up to half of patients have another family member with KP suggesting a genetic inheritance pattern. It is more common in siblings and twins.

There are several subtypes of KP:

• Keratosis pilaris alba: grayish white papules without surrounding redness

• Keratosis pilaris rubra: marked redness surrounding an area of KP

• Keratosis pilaris rubra faciei: KP loated on the face

• Keratosis pilaris atrophicans: a set of related disorders described be KP followed by atrophy (thinning and depression of the upper layers of skin with wrinkling). This type can cause scarring.

• Keratosis pilaris atrophicans faciei: also known as ulerythema ophryogenes; this is a very uncommon form of KP atrophicans located on the face, especially the cheeks. This type can cause scarring and hair loss in the area.

Diagnosis: There is no specific blood or skin test to make the diagnosis. Typically, examination of the skin is sufficient. When the diagnosis is in question, a dermatologist can perform a skin biopsy.

Treatment: No single treatment is effective for all people. Sometimes, KP resolves without treatment. Generally, measures to soften the keratin are the most common.

• Skin care: use a mild soap and liberal use of skin lubricants (creams) such as Vanicream, Lubriderm, or Cetaphil

• Exfoliant creams: These topical measures include acids (alpha-hydroxy, lactic, salicylic) or urea to loosen the dry skin. Although these tend to work, they frequently cause skin irritation with redness and stinging, thus making it unsuitable for young children.

• Retinoid creams: These Vitamin A derivatives include Retin-A. These products are also associated with skin irritation including burning.

• Steroid creams: when there is significant inflammation (redness, burning, itching), a medium potency steroid cream in an ointment can be beneficial. This is not designed for long term use but rather for 7 to 10 days.

• Immune-modulating creams: Pimecrolimus (Elidel) and tacrolimus (Protopic) are approved for treating eczema but may be beneficial in some patients with more resistant KP.

• Experimental treatments: These include light therapy (photodynamic therapy, pulse light, blue light), laser hair removal, chemical peels, dermabrasion, microdermabrasion, and oral isotretinoin (usually used for severe acne).

It is important to weigh the benefits of the above treatments with the risks of long term use, as KP is long lasting (usually) and many times improves spontaneously.

At Family Allergy Asthma & Sinus Care, we can help identify and guide treatment options for skin disorders including allergic eczema and KP in conjunction with your dermatologist. Don’t let “chicken skin” turn your day into a “fowl” day!