Keratosis Pilaris (KP) is a very common condition where the skin—most commonly on the upper arms—feels bumpy. You can also get KP on the thighs, buttocks and on the lower cheeks. Sometimes people will grow out of it in adulthood. This is especially true on the face, where most children do eventually outgrow it. It is usually asymptomatic and improves, in most, in humid environments, in the summer and with sun exposure. It is felt to be primarily genetic and is more commonly seen in people with dry skin, atopic dermatitis and eczema.
Sometimes KP has a white bumpy look consisting of pinhead sized individual scattered bumps and sometimes it looks like pink pinhead size individual bumps or spots. The white type is more responsive to treatment although, in general, it is very difficult to treat. So, before I discuss treatment, I want to give you realistic expectations on what treatment can do. It can improve the look and feel of KP but it will not cure KP or take it away entirely. Unfortunately, when you stop treatment, the KP will return.
Now onto treatments. For starters, you need to use very gentle soaps and lotions and constantly moisturize but do not over-wash. You can refer to my Past Advice on my website (www.socialderm.com) under Tips #17 and #9 for what moisturizers and lotions I recommend. If you are not able to see a dermatologist and want to start with OTC treatments, I would start with CeraVe SA renewing lotion with 3% salicylic acid and Eucerin Intensive Foot Repair with urea and lactic acid. These can be pretty irritating so I recommend alternating using them in the evening using them only once or twice a week each in the beginning (use one on Monday and Friday and on Wednesday use the other and then switch the next week.) If you are not irritated after using them for 3 weeks, I would increase to using them every other night.
It’s likely that you will experience some irritation at some point so you will need a topical steroid to counteract the irritation (redness, burning and dryness). In the US, you will have to settle for hydrocortisone 1% ointment since anything stronger would require a prescription. But if you have access to a medium strength steroid such as triamcinolone 0.1% ointment, that would be better. Use the steroid instead of the medicated lotion at night for a couple of days so you can treat the irritation and take a break from the medicated lotion which is causing the irritation.
If you have tried OTC treatment, your doctor can prescribe a topical retinoid and medium potency steroid. This does work but the irritation can limit your ability to use the retinoid. I typically start out by prescribing Differin lotion 2 times a week and increasing treatment by one day every 2-3 weeks until irritation starts. Once irritation develops, I have the patient start using triamcinolone 0.1 ointment or Topicort 0.05% cream (although I prefer ointments in this case) for a couple of days and then restarting the Differin lotion on a less frequent basis once the irritation has resolved. If you are tolerating Differin and the KP is not resolved I will step up treatment to Tazorac 0.05% cream once or at most twice weekly again combating irritation with medium potency steroids. Breaks from the retinoids (Differin and Tazorac) are good and often needed. Irritation is very likely but consult your dermatologist on the best application schedule for you!
You can use some of these treatments in children but I don’t recommend it since they are very irritating and KP is a benign condition. Also, most kids don’t even know they have it and so you just draw attention to it if you start treating or fussing over it. I recommend treating it only when the child or adolescent starts to become self conscious about it, and it’s always best to start treatment in “long sleeve weather” if you live in an area that allows for that since you can hide any irritation you are trying to work through getting to know how to use your new lotions/creams!