Keratosis pilaris (KP) is a common skin condition that affects millions of people around the world. While keratosis pilaris can occur year-round, it is especially common during the winter months. In this article, we will go over the causes and symptoms of keratosis pilaris. We will also discuss how to manage keratosis pilaris in the winter, and how to take precautions against it. Finally, we will discuss a winter routine to mitigate KP symptoms.
What is Keratosis Pilaris?
Keratosis pilaris (KP) is a cosmetic skin condition that most commonly affects teenagers and appears on the upper arms, buttocks, thighs, and cheeks. They are cosmetically unappealing because they are characterized by tiny, flesh-colored to slightly red bumps that give the skin a sandpaper-like texture. Kp seems to be linked to a variety of other conditions, including atopic dermatitis, ichthyosis vulgaris, obesity, type 2 diabetes, and malnutrition. It can also appear alongside syndromes such as Down syndrome and Noonan syndrome [1]. Unless the symptoms are severe or the lesions become infected, there is no need for treatment. In the winter, these bumps can become more pronounced due to cold, dry air and increased skin dryness, leading to increased irritation and itchiness.
Figure 1: Upper legs, Female 22 [2]
What causes Keratosis Pilaris?
Figure 2: Normal follicle vs a plugged follicle in Kp [3]
The cause of keratosis pilaris is unknown [4] but is thought to be related to a buildup of keratin, a protein found in the outer layer of skin. This buildup blocks the hair follicles, creating small bumps. Mutations in the filaggrin gene may cause the follicular abnormalities seen in keratosis pilaris [5]. Atopic dermatitis is the most common cause of keratosis pilaris. This link, along with mutations in the filaggrin gene, suggests that Kp is caused by a loss of normal epithelial barrier function [6].
The condition often improves over time, but several treatment options are available including lubricating creams and lotions, chemical peels, and laser treatments. However, it is usually not necessary to treat the condition and it usually goes away on its own over time.
What is the treatment for Keratosis Pilaris?
To help mitigate Kp symptoms, it’s important to establish a winter routine. Here’s what it should include:
1. Hydrate:
Drink plenty of water throughout the day to stay hydrated and flush out toxins.
2. Moisturize:
Moisturizing is an important part of keratosis pilaris treatment. Regularly slathering a fragrance-free, non-comedogenic moisturizer softens and hydrates the skin, which can help reduce the appearance of bumps and make the skin look and feel smoother. It is critical to use a moisturizer that is specifically formulated for dry, sensitive skin to avoid further irritation. Knowing how moisturizers work to prevent dry skin, a key Kp risk factor. I suggest reading up on it here.
Look for moisturizers with keratolytic ingredients like lactic acid, salicylic acid, or urea, which can exfoliate the skin and reduce the appearance of bumps. (The use of salicylic acid lotion 6% or urea cream 20% improves skin texture) [7].
3. Avoid harsh cleansers:
Harsh cleansers can irritate and dry out the skin, exacerbating the condition. Instead, a gentle cleanser free of harsh chemicals and fragrances is recommended. Mild cleansers containing natural ingredients like coconut oil or shea butter can help soothe and moisturize the skin.
4. Avoid hot showers:
Hot showers can aggravate Kp symptoms by drying out and irritating the skin even more. As a result, it is critical to keep shower water lukewarm or cool to avoid further irritation.
Additionally, taking shorter showers and using gentle, soap-free cleansers can help to alleviate Kp symptoms.
5. Exfoliate:
Exfoliation aids in the removal of dead skin cells as well as the unclogging of pores, allowing moisturizers and other treatments to penetrate the skin more effectively. In this case, the most effective exfoliant is a gentle physical exfoliant, such as a facial scrub or a loofah sponge. This type of exfoliation helps to gently slough off the top layer of dead skin cells, which can aid in the reduction of keratosis pilaris bumps. Exfoliation should be done gently, as excessive exfoliation can irritate the skin further.
Moreover, it has been proven that chemical peels containing 70% glycolic acid and applied for 5 to 7 minutes can help improving the appearance of KP [8]. Glycolic acid is an AHA that is highly recommended in Kp, but BHA body wash can be used for a deeper chemical exfoliation to eradicate dead cells deeply. I know it is confusing to choose which exfoliating molecule to go with but this article will make it easier for you.
6. Protect:
Cover up in cold weather with gloves and a scarf to protect the skin from the elements.
7. Omega-3 supplements:
Omega-3 fatty acids are necessary for proper skin health. They have anti-inflammatory properties and aid in the reduction of redness and itching. They also help to strengthen the skin's natural barrier, which can help to prevent keratosis pilaris flare-ups. Omega-3 supplements have also been shown in studies to help reduce the appearance of bumps caused by keratosis pilaris [9].
Before taking any supplements, consult with your doctor to ensure that they are safe for you due to Omega-3’s interaction with certain medications.
Finally, winter can be a difficult time for people who have keratosis pilaris. The cold and dry air can aggravate symptoms and make management more difficult. However, with the right preventative measures and treatments, keratosis pilaris can be minimized during the winter months. You can help keep your skin healthy and comfortable by moisturizing regularly, using gentle exfoliants, and taking lukewarm showers.
References:
1. Arnold, A. W., & Buechner, S. A. (2006). Keratosis pilaris and keratosis pilaris atrophicans faciei. In JDDG (Vol. 4, Issue 4, pp. 319–323). Wiley. https://doi.org/10.1111/j.1610-0387.2006.05933.x
4. Hosking, A.-M., Elsensohn, A., Makdisi, J., Grando, S., & de Feraudy, S. (2018). Keratosis pilaris rubra with mucin deposition. In Journal of Cutaneous Pathology (Vol. 45, Issue 12, pp. 958–961). Wiley. https://doi.org/10.1111/cup.13365
5. Fenner, J., & Silverberg, N. B. (2018). Skin diseases associated with atopic dermatitis. In Clinics in Dermatology (Vol. 36, Issue 5, pp. 631–640). Elsevier BV. https://doi.org/10.1016/j.clindermatol.2018.05.004
6. Thomas, M., & Khopkar, U. (2012). Keratosis Pilaris Revisited: Is It More Than Just a Follicular Keratosis? In International Journal of Trichology (Vol. 4, Issue 4, p. 255). Medknow. https://doi.org/10.4103/0974-7753.111215
7. Cohen, L., Seminario-Vidal, L., & Lockey, R. F. (2020). Dermatologic Problems Commonly Seen by the Allergist/Immunologist. In The Journal of Allergy and Clinical Immunology: In Practice (Vol. 8, Issue 1, pp. 102–112). Elsevier BV. https://doi.org/10.1016/j.jaip.2019.07.019
8. Reserva, J., Champlain, A., Soon, S. L., & Tung, R. (2017). Chemical Peels: Indications and Special Considerations for the Male Patient. In Dermatologic Surgery (Vol. 43, Issue 2, pp. S163–S173). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/dss.0000000000001281
9. Piccardi, N., & Manissier, P. (2009). Nutrition and nutritional supplementation. In Dermato-Endocrinology (Vol. 1, Issue 5, pp. 271–274). Informa UK Limited. https://doi.org/10.4161/derm.1.5.9706