Keratosis Pilaris 101

Keratosis pilaris, or keratosis pilaris, is a common cornification disorder that causes keratinized, rough-to-the-touch papules on the skin. The disorder is very common and mostly affects teenage girls. The complaints are mostly of a purely cosmetic nature and can generally be treated well with hygiene measures and ointments, but cannot be cured.

What is keratosis pilaris?

Keratosis pilaris is a visual diagnosis that can be made by the general practitioner or dermatologist. For a more detailed examination, dermatoscopy can be used. See AbbreviationFinder for abbreviations related to Keratosis Pilaris.

Keratosis pilaris (also known as lichen pilaris, keratosis follicularis, keratosis lichen planus or colloquially keratosis pilaris) is a presumably genetic cornification disorder that affects the skin or hair follicles primarily in the upper arm, thigh and face area.

Follicular hyperkeratosis develops. This means that the structure-giving protein keratin is produced in excess, causing hardened nodules to form on the skin’s surface.

Causes

Keratosis pilaris develops when the protein keratin, which is also found in hair and nails and is responsible for their stability, is produced in excess in the hair follicles (follicular hyperkeratosis). This thickens the epidermis and clogs the follicle opening, resulting in the typical grater texture of the skin.

The basic cause of the keratinization disorder is unclear, but a genetic predisposition is considered certain, since keratosis pilaris runs in families. If one person is affected, the probability for other affected family members is 50 to 70 percent. The corresponding gene is probably inherited in an autosomal dominant manner.

Symptoms, Ailments & Signs

Patients with keratosis pilaris have a typically grater-like rough skin surface. About the size of a pinhead, cone-shaped papules form, the appearance of which is reminiscent of so-called goosebumps. Because keratin is deposited in the hair follicles, the bumps are hard and rough.

Sometimes it happens that the keratin plugs seal off the hair follicle from the outside, so that regrowing hair cannot grow out through the skin, but instead rolls up in the follicle. Such ingrown hairs can, in rare cases, become painfully inflamed. The main areas affected by keratosis pilaris are the upper arms and thighs.

In some cases, the face, neck, scalp and buttocks can also be affected. The symptoms are usually purely cosmetic in nature, but can be quite stressful for those affected, especially during puberty. Only very rarely does itching or pain occur.

Diagnosis & course of disease

Keratosis pilaris is a visual diagnosis that can be made by the general practitioner or dermatologist. For a more detailed examination, dermatoscopy can be used. Since cases of keratosis pilaris often run in families, taking a family history is helpful in making the diagnosis.

Several different subtypes can be distinguished diagnostically, including keratosis pilaris rubra, which leads to red, inflamed elevations on the arms, legs and head, keratosis pilaris alba, in which the cornifications do not become inflamed, and keratosis pilaris rubra faceii, which shows on the face. Keratosis pilaris does not lead to any health restrictions.

However, if symptoms occur in atypical places, other skin diseases should be excluded in the differential diagnosis. In addition, keratosis pilaris often occurs in connection with diseases such as neurodermatitis, bronchial asthma, allergies or ichthyosis vulgaris, so that further diagnostics for these diseases can be carried out if the symptoms are appropriate.

The disease can appear relatively unchanged over the years, but tends to decrease or disappear completely with increasing age. Puberty, pregnancy and lactation, on the other hand, often lead to stronger flare-ups. Scratching the calloused areas can lead to local inflammation that worsens the local symptoms.

Complications

As a rule, keratosis pilaris does not result in a health-endangering condition for the patient. This disease is mostly a cosmetic problem. As a result, girls in particular often suffer from mental health problems or depression. Furthermore, bullying or teasing can also occur in children, which often leads to the development of an inferiority complex or reduced self-esteem.

Especially in puberty, keratosis pilaris can be very stressful for children and significantly reduce their quality of life. In some cases, patients also suffer from pain or itching. Furthermore, keratosis pilaris also occurs in allergies or diseases of the respiratory tract. If those affected also suffer from these symptoms, it is advisable to consult a specialist.

The treatment of this disease is usually carried out with the help of medicines and care products. This can limit most complaints. Increased personal hygiene often helps to combat this disease. No other complications arise. Keratosis pilaris does not affect the life expectancy of those affected.

When should you go to the doctor?

Cornifications of the skin are considered unusual, especially in children, and should be clarified by a doctor. Although there is no cure for keratosis pilaris, medical treatment can be given to improve symptoms. A doctor’s visit is required so that the cause of the changes in the skin’s appearance can be examined in tests and a diagnosis made possible.

If the existing skin abnormalities and peculiarities spread or if the complexion deteriorates in the affected areas, it is advisable to consult a doctor. If papules develop, if there is swelling or if there is no physical hair growth in the diseased regions, a doctor should be consulted. If inflammation occurs, pus forms or the hair that grows back turns into the skin, a doctor’s visit is recommended. In the case of itching and the development of open wounds, care must be taken to ensure sterile wound care.

If this cannot be guaranteed or if existing wounds enlarge, a doctor must be consulted. In severe cases, there is a risk of blood poisoning, since germs can penetrate the body via the body parts. If the affected person suffers emotionally from the skin changes, a doctor should also be consulted. Therapeutic support is required for behavioral problems, personality changes or severe mood swings.

Treatment & Therapy

Keratosis pilaris cannot be cured by therapeutic measures. However, its symptoms can be alleviated until the keratinization disorder may go away on its own as the sufferer ages. The most relevant measures include personal hygiene and can be carried out by the patient himself.

Regular cleaning of the affected areas is important. For this purpose, soapy lotions should be avoided completely or at least pH-neutral soap should be used. Patients should also not take excessively long showers in order not to dry out the skin. The affected areas should then be cared for with lipid-replenishing and moisturizing lotions.

Care products with urea are particularly advantageous, as this binds moisture and loosens calloused areas. Other medicated ointments contain salicylic acid, hydroxycarboxylic acids, or lactic acid. If necessary, these creams can also be applied overnight as a care mask. If these everyday hygiene measures are not sufficient, peelings with salicylic, lactic or fruit acids can help to remove the horny plugs.

However, both medicinal ointments and acid peelings should be used only in consultation with the attending physician. In more severe cases, ointments containing glucocorticoids (cortisone) can also be used. Laser therapy is also possible, but like the ointments mentioned, it only promises relief, not healing. Basically, keratosis pilaris patients should make sure they drink enough and moderately expose themselves to the sun to stimulate vitamin D production.

Outlook & Forecast

If keratosis pilaris, also known as keratosis pilaris, is present, the affected person can usually take care of the treatment themselves. moisturizerswith urea keep the skin supple and promote faster desquamation, which reduces cornification. With the help of peelings, dead skin cells are removed and the complexion is improved both visually and haptically. Chemical peels based on ingredients such as salicylic acid, fruit acid or lactic acid can help here.

Mechanical peelings, for example with callus rasps or pumice stones, are not recommended, as these can easily injure the damaged skin and this may cause inflammation. If the skin is particularly sensitive, the patient can alsocreamsresort to vitamin A. These achieve a similar effect to chemical peels, additionally stimulate the formation of new cells and are gentler on the skin.

Manche Betroffene stellen im Sommer bei erhöhter Sonnenstrahlung eine Besserung des Hautbildes fest. Sie können mit einem Dermatologen die Möglichkeit einer Lichttherapie besprechen, welche anders als im normalen Solarium direkt auf die individuellen Bedürfnisse angepasst wird.

In einigen Fällen führt eine Ernährungsumstellung zu einer deutlichen Verbesserung der Symptome. Dabei ist es individuell unterschiedlich, ob der Verzicht auf Suchtmittel, Zucker, Kaffee oder sogar Gluten eine Besserung bewirkt oder eher die Umstellung auf eine vitaminreiche Ernährung mit ausreichender Flüssigkeitsaufnahme.

Prevention

Keratosis pilaris cannot be completely avoided with the appropriate disposition. However, the symptoms can be significantly alleviated or even prevented in advance with adequate care and precautionary measures. These measures are particularly important in winter, since the so-called keratosis pilaris is particularly severe at this time. This is where many of the treatment measures already mentioned come into play (cleansing, creaming with medicinal ointments, if necessary, peelings).

Aftercare

Those affected with keratosis pilaris usually have very few follow-up measures available. These are severely limited, so that a quick and, above all, early diagnosis should be made by a doctor. A doctor should be contacted as soon as the first signs or symptoms of the disease appear, so that no further complications or symptoms arise.

Keratosis pilaris cannot heal itself. Treatment is usually through the use of various creams or ointments. The person concerned should always pay attention to the correct dosage and regular use in order to relieve the symptoms properly and, above all, permanently. If you have any questions or are unclear, you should always consult your doctor first.

The symptoms rarely go away on their own, so a doctor should be contacted if treatment does not produce the desired result. Since keratosis pilaris can also reduce the aesthetics of the person affected, intensive and loving conversations with one’s own family or friends are very helpful. This can prevent psychological problems or even depression. As a rule, keratosis pilaris does not reduce the life expectancy of the affected person.

You can do that yourself

Keratosis pilaris usually does not require medical treatment. Those affected can alleviate the keratosis pilaris by determining the causes of the cornification and then taking specific countermeasures.

Regular care of the affected body regions is particularly important. Frequent peelings help to remove dead skin cells and thereby improve the complexion. Applications with salicylic acid are particularly effective because the active ingredient has an anti-inflammatory effect and dissolves constipation. Various oils, such as olive, coconut or argan oil, also ensure a cleaner skin surface. In some cases, sun rays improve the condition of the skin. Seawater is also said to help and can be applied pure or in the form of ointments and lotions.

In addition, a healthy diet is recommended, which should contain as little gluten as possible and as much fresh fruit and vegetables as possible. Too much sugar and stimulants such as alcohol, nicotine and coffee should be avoided. Those affected should also drink plenty of water. Regular visits to the sauna give the skin additional moisture. Sport and avoiding stress support these measures and improve overall well-being. If the keratosis pilaris does not decrease despite everything, it is best to consult your family doctor or a dermatologist.