Keratosis pilaris: cause, treatment & when to see a dermatologist

Keratosis pilaris is a common, benign skin condition where small keratin plugs clog the hair follicles. This results in a rough "chicken skin" feeling on the skin, surrounded by slight redness. The condition is completely harmless and poses no health risks.

It is also commonly referred to as "chicken skin" or "goosebumps." Other medical terms include lichen pilaris and follicular keratosis.

An estimated 40 to 50% of all adults have keratosis pilaris to varying degrees. Among children and teenagers, this percentage is even higher. Precisely because the condition is so common, it is often recognized late or confused with other skin problems.

Keratosis pilaris develops when the skin produces too much keratin. This keratin accumulates around the hair follicles, forming small plugs that clog them. The result: rough skin with small bumps.

The condition is passed down genetically. If a parent has keratosis pilaris, there's a significantly higher chance that their children will also develop it. People with atopic eczema or dry skin (eczema) are more frequently and severely affected by keratosis pilaris.

Keratosis pilaris is also seasonal: symptoms are worst in autumn and winter with low humidity, and spontaneously improve for many people in the summer. Keratosis pilaris is not an infection, not an allergy, and not contagious. You cannot pass it on to others.

The typical presentation of keratosis pilaris consists of small, hard bumps on the skin with a rough texture, similar to persistent goosebumps. The bumps are surrounded by slight redness or discoloration.

For light skin, the bumps are red or pink. For darker skin, they tend to appear brown or grayish, making the condition less easily recognized. The bumps are not painful and rarely itch, unless the skin is extremely dry.

Keratosis pilaris is sometimes confused with acne on arms, but there are clear differences. With keratosis pilaris, there are numerous bumps without a whitehead or inflammation, typically on the upper arms and thighs. Acne, on the other hand, involves pimples with a whitehead or pus, on the face, back, or chest, with visible inflammation. Unsure? Send a photo via Skindr: a certified dermatologist will review it within 48 hours.

The progression is reassuring: symptoms are worst during puberty and improve for many people after the age of 30.

Keratosis pilaris most commonly appears on the outer sides of the upper arms, which is the most frequent location in adults. The upper legs and buttocks are also often affected, more so in women than in men. In young children, the bumps regularly appear on the cheeks. Less common locations include the back and shoulders.

Keratosis pilaris never occurs on the palms of the hands or soles of the feet, as hair follicles are not present there. In people with darker skin, redness is less noticeable, but the rough texture is the primary indicator of the condition.

Keratosis pilaris cannot be fully cured, but its symptoms can be well managed with proper care. Most people find relief with over-the-counter products.

The foundation of treatment is daily moisturizing after showering. Creams containing urea (5 to 20%) are effective: they dissolve keratin plugs and are available over-the-counter at pharmacies. Creams with salicylic acid (2 to 5%) also exfoliate the keratin layer and are a good alternative. Avoid hot water and harsh scrubs, as these damage the skin barrier and worsen the bumps.

If over-the-counter creams are not sufficient, a dermatologist may recommend retinoic acid or adapalene as a treatment plan. More information about retinoids for skin conditions can be found via DermNet NZ. For more severe cases or persistent redness, laser treatment is an option, such as a KTP laser or Nd:YAG laser. These treatments are only available through a dermatologist.

Want to know which approach is best for your skin? Through Skindr, you'll receive advice from a certified dermatologist within 48 hours, based on a photo and without a waiting list. According to huidziekten.nl , keratosis pilaris affects an estimated 40% of the population.

Harsh scrubs or a pumice stone might seem logical, but they damage the skin barrier and worsen redness. The keratin plug is deep within the hair follicle: squeezing or picking carries a risk of infection and doesn't help. Stopping care as soon as the skin improves also doesn't work: keratosis pilaris always returns without consistent follow-up. Finally, dry indoor air exacerbates symptoms in winter: a humidifier can make a helpful difference.

Does keratosis pilaris go away on its own?

For many people, symptoms improve after the age of 30, but keratosis pilaris rarely disappears completely. Consistent skincare with urea or salicylic acid helps manage the symptoms. Without care, the bumps always return.

What is the best treatment for keratosis pilaris?

Creams with urea (10 to 20%) or salicylic acid are the most effective over-the-counter options. Prescription retinoids work better for stubborn cases. A certified dermatologist can advise on the most suitable approach for your skin.

Is keratosis pilaris the same as acne?

No. Keratosis pilaris is caused by keratin plugs in hair follicles and typically appears on the upper arms and thighs. Acne is an inflammation of the sebaceous glands and is primarily found on the face, back, and chest.

Can I pass keratosis pilaris on to my children?

Keratosis pilaris is genetically determined and can be inherited, but it is not contagious. If a parent has it, there's a higher chance their children will also develop it.

When should I see a dermatologist for keratosis pilaris?

If over-the-counter creams don't help sufficiently after 3 months, if redness or roughness increases, or if you are considering laser treatment. Through Skindr, you will receive advice within 48 hours.

1. Skindr dermatologists: skindr.com
2. DermNet NZ: Keratosis pilaris
3. Huidarts.com: Keratosis pilaris
4. Thuisarts.nl