John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Keratosis Pilaris

Patient Information Sheet

Keratosis pilaris is a very common condition in which strands of dead skin wrap around hairs in the upper part of the hair follicle. This produces little white head, acne-like bumps about 1 mm in size or less. Although it may look like acne, it is different. When you pinch out acne blackheads, they are ball or nodule like. If you grasp the plug of dead skin in a keratosis pilaris hair follicle, you can tease it out dragging out a thin strand. That's the part wrapped around the hair. So, even though it can look acne like and even have little pustules, it is a different condition.

Keratosis pilaris occurs on the sides of the upper arms, upper legs, buttocks, and hip areas. It is not contagious. It is not an infection. Sometimes the bumps become infected but not often. It is usually just a nuisance and does not present a threat to health.

Keratosis pilaris is inherited as an autosomal dominant gene. This implies that a person with keratosis pilaris has a 50% chance of passing it on to each child. If the child inherited the keratosis pilaris genes, one each from each parent, the probability is 75% that child will have keratosis pilaris. However, it is not a reason not to have kids, because it is not bad, and it is not associated with anything bad. It is associated with atopic dermatitis.


Notice that I say management not cure. There is no permanent cure. It is possible to manage it so that it is less noticeable. These strands of dead skin wrapped around the hairs in the upper part of the hair follicle are more noticeable when dry and brittle. They are more of a problem in dry and cold weather when the skin is dry. They will improve if you go to Hawaii where the humidity is 87%. Let me know if you need a doctor's order for a trip to Hawaii.

Measures aimed at keeping the skin wet will allow the little strands and plugs of dead skin to loosen up and come out. This is achieved by leaving the skin in those areas a little wet after bathing. Pat them with a towel and leave little beads of water on the skin. While still wet, quickly rub a bath oil or dry skin lotion into the affected areas. You are trying to seal the water in. Otherwise, the air is so dry here, all the water will evaporate out in 5 minutes.

The next step up is to use alpha-hydroxy acid lotions such AmLactin (12% lactic acid) when you get out of the bath. Or wet the skin and rub in AmLactin. Alpha hydroxy acids like lactic acid are remotely like citric acid in fruit. The AmLactin line of products is confusing. I suggest trying AmLactin Daily Lotion.

Another thing worth trying is a BUFF PUFF. It is a pad made of small stranded fibers. When you are in the shower, rub the Buff Puff over the keratosis pilaris. The fine fibers snag the tops of the dead skin plugs and yank them out. You are not trying to sandpaper them down. You want to catch them on the sponge fibers and pull them out.

If these simple measures do not work, we can try Retin A Micro 0.04%, a prescription acne medicine. Retina A "normalizes" the formation of the dead cells layer. It inhibits the formation of the plugs of dead skin. It is preventive and so takes 2-6 weeks to see a result. It usually works well. But, when you stop using it, the keratosis pilaris comes back. It just controls it, not cures it.

I think the simplest things usually work best. Start with the Buff Puff and bath oil. Give it two months. If that does not work, we can talk about Retin A.

The most severe and most widely disseminate case I have had was in a young lady who had it since early childhood. Nothing helped her. Out of desperation, we used a 4 months course of Accutane. This helped a lot for about 4 years. Accutane is a big commitment, very expensive, and not approved by the government for this use.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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