How to treat keratosis pilaris

What treatment is trying to change

Keratosis pilaris forms when keratin builds up in hair follicles instead of shedding normally, leaving small rough bumps. Keratin is already a normal material in skin, hair and nails; in keratosis pilaris, follicles turn it into a long term tenant. The bumps commonly appear on the upper arms and thighs, and can also affect the buttocks or other areas. Skin can feel dry or itchy, and the bumps may match the skin tone, look red, or appear darker. Keratosis pilaris often looks more prominent in winter, when the air has less moisture.13

How to build a routine

1. 1Shower or bathe with cool or lukewarm water and use mild, unperfumed bathing products.
2. 2Within 5 minutes after every bath or shower, while the skin is still damp, apply a creamy moisturizer.
3. 3Gently massage moisturizer into the affected areas at least 2 or 3 times a day.
4. 4For surface scale, gently use a washcloth, loofah, exfoliating mitt or sponge. Avoid harsh scrubs, and do not scratch, pick or rub the skin.
5. 5If you use an exfoliating medicine, follow the dermatologist's amount and schedule. Pause it for a few days if your skin becomes dry or irritated.

Best ingredients for keratosis pilaris

For dryness or itch, a moisturizing cream with urea or lactic acid is a practical place to start. Creams with urea, salicylic acid, lactic acid or alpha hydroxy acids can also moisturize or loosen scale in the follicles. For rough bumps, a dermatologist may recommend an exfoliating medicine containing glycolic acid, lactic acid, a retinoid, salicylic acid or urea. These are options to discuss, not a list of ingredients you need to use all at once.12

Alpha hydroxy acids, beta hydroxy acids and urea all have potential benefit for keratosis pilaris, but the available evidence is limited by small samples, varied outcome measures and limited blinding. Acid strength matters: high concentrations increase the chance of skin inflammation, especially for sensitive skin.45

What a clinician can add

For itch, a clinician may use a short course of moderate strength steroid cream; some people also need a corticosteroid to soften bumps and reduce redness. If moisturizer and medicine are not enough, a dermatologist may discuss laser or light treatment. Different treatments can target redness, swelling, skin texture or discoloration; pulsed dye laser and intense pulsed light can reduce redness temporarily, but it often returns.126

When to expect a change

Give a treatment plan 4 to 6 weeks, and tell your dermatologist if you have not seen improvement by then. Some people need to try a few treatments before finding one that helps. To keep results, a maintenance plan might mean using medicine twice a week instead of daily, or switching to a nonprescription moisturizing cream. Keratosis pilaris does not come with a finale; maintenance is part of the arrangement. The condition may improve through adulthood, and clearing often happens gradually over many years.27

When to ask a clinician

Ask a pharmacist if self care is not helping and the condition bothers you, if the skin becomes itchy or inflamed, or if you are unsure whether to see a doctor. If a child's rash is not clearly keratosis pilaris, get medical advice rather than assuming the bumps are the same condition. Facial bumps around the eyebrows with eyebrow hair loss need assessment, because an uncommon form of keratosis pilaris can cause permanent hair loss.36