As the weather warms and we start switching back to T-shirts, tank tops, and shorts those lovely little red bumps on our arms and legs are getting noticed again!
Enjoy this read and, as always, click the numbers in square brackets to check out all the references!
What is Keratosis pilaris?
Keratosis pilaris (KP) is a group of skin issues where you get a hyperkeratosis of your follicles [i]. That means you get thickened keratin build up that plugs your body hair follicles [ii] and creates little red bumps. Usually these bumps are on the upper arms, upper legs, and sometimes the torso (back, hips, etc.).
Who gets Keratosis pilaris and why?
This is an X-linked dominant genetic trait, meaning if both your parents have it you will as well [iii]. If only one does you might be in the clear! Any skin tone can have KP. It is more common among men than women [iv] but many women have to deal with it (myself included).
Some studies have shown that Vitamin B12 and Vitamin A deficiencies, hypothyroidism, and Cushing disease can worsen your KP [v]. It can also be worse for people with diabetes mellitus, other types of dermatitis, and obesity [vi].
Common myths about where Keratosis pilaris comes from:
I have heard people say KP comes from eating wheat, eating dairy, eating chocolate, drinking alcohol, and so on. Nope!
How to treat Keratosis pilaris
Many people who have KP as teens will get reduced symptoms as they age [vii] (sadly not the case for me!). Otherwise there are keratolytic (excess skin peeling) ingredients you can look for to help reduce the appearance of KP. These come in body scrubs, creams, and toners. I definitely do not recommend trying to pop keratosis bumps because it doesn't help and can damage your skin and hair follicles.
AHAs (alpha hydroxy acids)
There are 5 types of AHAs: glycolic acid, lactic acid, citric acid, malic acid, and tartaric acid [viii]. The two you will find in KP creams are lactic acid (cream formulations of at least 10%) [ix] and glycolic acid (formulations of at least 7%) [x].
BHAs (beta hydroxy acids)
There is only one BHA that is used very commonly for skin and that’s salicylic acid. Formulations of at least 5% are best for KP [xi].
*I will be doing an article just about AHAs vs. BHAs so stay tuned!
Urea comes from the body using and processing proteins and gets released from the body via sweat and urine. It is used very commonly in skincare as it is both gently exfoliating and moisturizing. This makes it especially good for KP treatment! Formulations of 10-20% have been shown to be effective [xii] but if you have sensitive skin I would start as low as 5% urea and not jump straight into 20%.
A few studies were able to show that using combinations of the acids worked best since they could treat the KP synergistically. Some combos listed were:
2% salicylic acid + 20% Urea [xiii]
Salicylic acid and glycolic acid (acid percentage not specified) [xiv]
Topical application of retinoids like tretinoin or tazarotene can work, especially if acids do not [xv]. That said there is quite a bit of variability on how effective they are. I will be doing a deep dive on retinoids so for this piece I will just leave it there.
If you have substantial redness and inflammation you can see a doctor and they may prescribe a topical steroid. These quickly improve the inflammation but shouldn’t be used constantly or long term [xvi].
Laser therapy, especially the QS:Nd laser, has been shown to reduce KP bumps and inflammation [xvii, xviii]. The only issue is there can be side effects like severe changes in skin pigmentation, swelling, and possible pain [xix]. Keep in mind this is something you need to get done by a dermatologist.
Intense pulsed light (ILP) has been shown to reduce KP redness and roughness after as little as 3 light therapy sessions [xx, xxi]! I wasn't able to find any negative side effects. Like laser therapy, someone qualified has to do this.
Remember to Moisturize!
It’s important to keep in mind that treating KP is a combination of removing the build-up in your pores as well as keeping skin moisturized consistently [xxii]. In practice this means either buying products that both exfoliate and moisturize or making sure to moisturize after using any of the treatments.
There seem to be a lot of options available to try, some of which are over the counter and some of which require a dermatologist. I have tried a 10% glycolic acid body scrub which works ok as well as 10% glycolic acid toner which hasn’t been especially effective. I will try a different acid and see how that goes!
The key thing I have read is that consistency is important. If you aren’t using the product daily you likely will not see changes. Also just because something works or doesn’t work on someone else’s KP doesn’t mean it isn’t worth trying for you!
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