Keratosis Pilaris: The Skin Issue That Can Drive You Mad

Do you suffer from those teeny tiny red bumps on the back of your arms — maybe even on the tops of your thighs or your tush, too? The good news is they are probably not pimples. The bad news is they’re most likely a totally common skin condition called keratosis pilaris.

When it comes to KP, there’s a surprising amount that dermatologists do and do not know about it. That's because, like acne, there can be a number of underlying causes. Unlike acne, however, there isn’t a ton of research in it. The most common (and obvious) cause of KP: genetics.

“More women than men have it, three-quarters of adolescents will experience it, and sometimes it’s connected to eczema and dermatitis. But other than that, usually all we know is that someone’s mother had it and her mother had it, too,” says Neal Schultz, M.D., a dermatologist in NYC and founder of Beauty Rx. “And, in that way it is similar to acne — we don’t really understand why some get it and some don’t.”

What docs are sure of is that while some of aspects of these pesky bumps mimic pimples, they are not the same thing — at all. Instead of bacteria or pus under skin, KP is a result of over-keratinization (keratin are the structural protein molecules that make up layers of skin) that builds up on the surface and just keeps building and building and, well, building. Until bam! You’ve got a bunch of dead skin cells clogging up the opening of your hair follicles causing a slew of white-ish bumps or an all-over sandpaper-like texture (a.k.a. chicken skin) that’s red and inflamed. All of which leaves you grabbing a cardigan instead of showing off your triceps.

And, since the majority of teens get some form of it during puberty, docs realized there’s a hormonal connection (there are also claims that many women experience a KP surge when pregnant). However, the clear-cut science to back this up is lacking. “It does often come back during a time period of acne and may be tied to the release of estrogen, but research is needed to make the connection,” says Schultz.

As to why it’s often seen on the arms, legs, and butt, and more rare, the side of the face? Most likely because of the sheer amount of hair follicles in those spots. “It’s not known why it affects these areas more than others,” says Francesca Fusco, M.D., a dermatologist in NYC at Wexler Dermatology. And it seems that keratosis pilaris is a little temperamental about when it wants to flare up. “Factors which exacerbate it are different for each individual,” explains Fusco. “But, for example, patients who have eczema claim that when their eczema flares, so does their KP.”

Now, if you go ahead and Google ‘treating keratosis pilaris,’ the list of at-home remedies are long — and often odd. We're talking coconut oil, extremely rough washcloths, and the natural cure-all, apple cider vinegar. But, doctors stand by the fact that the only truly effective treatment is finding a careful balance of exfoliation and moisture.

“The solution is really 90% exfoliation and 10% hydration,” says Schultz, who swears by glycolic acid, over retinol, salicylic, or lactic acids. “Glycolic is the gold standard of chemical exfoliants because it doesn’t cause the irritation that can come along with the alternatives and it works better than physical kinds. I don’t have one patient whose KP hasn’t benefited from glycolic acid — we just might play with the amount, and start off at 10%, but go up to 15% or 20% for more severe cases,” he says.

Now, we’re not saying some body buffing won’t help at all, but for faster and more effective results, the chemical exfoliators are the way to go. As for the hydration factor: “The reason coconut oil is such a popular remedy is because it is helping moisturize the skin and skin retain its own moisture, as well as tones down redness,” says Schultz. And, it’s the lack of moisture, and further buildup of dead skin cells that make KP a thousand times worse in the winter than the summer. “When skin is dry, dead cells can’t turnover as easily as they normally would — combine that with someone who is prone to KP and the condition is exacerbated,” explains Schultz.

“The goal of treatment is to unclog and exfoliate the plugs of dead cells,” says Fusco, who prefers to treat KP with retinol. “Retinol not only unclogs, but helps to prevent re-clogging skin, especially when paired with microdermabrasion or ammonium lactate, which combines a gentle exfoliant with moisture.” Stick daily to one of the aforementioned smooth-skin game changers for a few weeks (remember: the top layer of skin takes at least 28 days to completely turnover) — as you won’t see a major change overnight. And try as hard as you can to keep your hands off (no picking!), which can just inflame skin further.