How is keratosis pilaris treated?

What should you do at home?

1. 1Wash with a mild, unperfumed bathing product or soap free cleanser. Use cool or lukewarm water rather than hot water, and avoid prolonged baths and showers.
2. 2Moisturize daily with a fragrance free cream. A pharmacist can help you choose a suitable moisturizer.
3. 3Add a topical exfoliant containing lactic acid, ammonium lactate, salicylic acid or urea. Start two to three times weekly, increasing slowly only as your skin tolerates it.
4. 4Between applications, avoid picking, scratching and rubbing the bumps. Avoid thick, tight or abrasive clothing that creates friction.

Moisturizing is a useful treatment step, despite lacking the plot twists promised by skincare marketing. Dryness often makes keratosis pilaris worse in winter, so moisturizing remains useful even when you are not exfoliating.25

Should you scrub the bumps?

Chemical exfoliants, also called keratolytics, gradually remove dead surface skin and flatten bumps. They are generally preferred to vigorous physical scrubbing. If you use a washcloth or exfoliating mitt, keep the pressure gentle; harsh scrubs can make the condition worse. Exfoliation treats texture, not the associated redness or itching. Reduce exfoliant use if dryness, redness, rash or irritation develops.13

What can a dermatologist prescribe?

Options include ammonium lactate lotions or creams, urea creams and topical retinoids, medicines applied to the skin that include tretinoin and adapalene. Examples used for keratosis pilaris include tretinoin 0.1% and adapalene 0.1%; these are treatment options to discuss, not instructions to start the strongest product. Tacrolimus and azelaic acid are additional options. Treatment products come as creams, lotions and gels, so the bathroom does not need to become a dispensary.6

Topical steroids can help redness or itching. Unless a clinician directs otherwise, use them only once or twice daily for no more than one to two weeks. Lasers are sometimes used for facial redness, particularly the red variant called keratosis pilaris rubra. Steroid creams and laser treatments are not usually available on the NHS because their effectiveness is not established, and private treatment can be expensive.136

How long does treatment take?

Allow weeks of consistent treatment before judging improvement. Continue maintenance treatment after the bumps improve, except for short courses of steroids. Responses differ, and treatments can be disappointing. Keratosis pilaris often improves with age: bumps starting in the teenage years often clear by the mid twenties, although some people continue to have them as adults.346

Who needs extra care?

Avoid acid creams in young children because they can burn and sting. If home care is not helping, or the skin becomes itchy or inflamed, speak to a pharmacist about treatment and whether you need a doctor. Larger, painful or pus filled bumps, or a sudden outbreak, need assessment rather than assuming they are keratosis pilaris.136

Facial bumps with eyebrow hair loss or scar like depressions also warrant a dermatologist's assessment. An uncommon form, keratosis pilaris atrophicans faciei, can cause permanent hair loss. Its treatment includes cleansers, keratolytic moisturizers and topical retinoids; sun protection helps because sunlight worsens its redness.7