How To Get Those Annoying Red Skin Bumps Under Control

Photographed by Heather Talbert.
For many of us, baring our arms and legs come summer is a pleasure. Unfortunately, moving away from the tights and switching from denim pants to cutoffs isn't as seamless for some as it is for others. Women who have keratosis pilaris (KP) may cringe at the thought of donning tank dresses or miniskirts for fear of exposing unsightly "chicken skin" — which is what KP is often called. This rough, bumpy skin is actually an extremely common condition — even if you don't have it, it's highly likely you know someone who does. I see at least one person a day with KP.

Like many conditions, KP is hereditary. It's inherited in an autosomal-dominant fashion with variable penetrance, which means that it takes just one gene from one parent to develop it. Not everybody with the gene has the condition, but approximately 30 to 50% of individuals with KP have a positive family history.

What Is Keratosis Pilaris?
KP is considered a disorder of keratinization, or the formation of epidermal skin. The buildup of keratin around the hair follicles traps the hairs underneath and results in the small bumps characteristic of KP. It is also often associated with other dry-skin conditions, such as eczema. If the bumps cause red or brown polka dots, it means the area has become inflamed.

Who Gets It?
KP can develop at any age, but typically starts in the first decade of life and worsens during puberty — 50 to 80% of adolescents have it. Although it tends to improve with age, approximately 40% of adults have it. And women are more prone than men.

How Is It Treated?
The condition may not be curable, but it is certainly controllable. Because it is medically harmless and mostly a cosmetic concern, you don't actually have to seek medical treatment. But there's certainly nothing wrong with trying to get it under control; the "wait-and-see" approach is not for everyone and it's not something I encourage my patients to do if it's making them really uncomfortable.

An important part of any treatment plan is preventing skin dryness. I usually recommend bathing with lukewarm water, and using gentle cleansers and emollients. Mild cases of KP may improve with these simple measures. Most treatments are aimed at smoothing away those unsightly bumps through exfoliation — either chemical or physical.

Photographed by Julia Robbs.
Topical Treatments
Glycolic, salicylic, and lactic acids work as chemical exfoliators and slough off dead skin cells to reveal smoother skin. There are several over-the-counter and prescription products containing these acids, and they come in a variety of forms — cleansers, creams, lotions, serums, or pads.

A urea cream is a prescription treatment used to reduce hyperkeratotic skin, and may improve the appearance of KP by breaking down and sloughing dead skin cells.

Retinoids can improve the appearance of KP by increasing cell turnover. They're a great option for people who also have acne or hyperpigmentation. Remember, though, that retinoids can be drying, so you don't want to slather them on; a little goes a long way.

Physical exfoliation with a loofah, a washcloth, or scrubs can be helpful, but being too aggressive can irritate the skin and lead to more dryness and exacerbation of KP.

Other Options
An alternative option is to seek professional help beyond a steroid prescription. Through a series of microdermabrasion treatments or chemical peels, you may rid yourself of those pesky bumps.

Photodynamic therapy, laser hair removal, and other laser treatments have been reported to be effective, but these are not well studied so might not be best option. I don't think it's necessary to get a procedure unless you've exhausted all topical treatments and worked with your doctor on next best steps.

Some treatments commonly used for eczema may work to combat KP as well, which is why I often recommend my patients give topical steroids a chance. Topical steroids are a popular choice because they work quickly, so they're great if you need a quick-fix before an event.

Although keratosis pilaris can be annoying and unsightly, smoother skin is possible. Once you find a skin-care regimen that works, stick with it and bare those arms and legs proudly (with sunscreen, of course).

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