What do you know about Keratosis pilaris?
Last updated date: 01-Dec-2021
13 mins read
Have you ever been asked what the largest body organ is?
Some people think it is an internal organ such as the liver or the spleen.
But if you give it much thought, the liver and the spleen are not the largest organs the human body has.
I mean, think about it. The human body has an organ that covers an average of 20 square feet. Have you figured it out?
It is the skin. The skin is the body's largest and heaviest organ.
The most obvious function of the skin is to protect the internal organs and the inside of the body from possibly harmful environments, however, there is much more to the skin than that.
Before we go to the various functions of the skin, let's discover the basics of the skin.
Let's talk about how it is constructed, what it does and how it does that.
So, let's start our journey with a simple question, what is the skin? How can we define it?
The skin is a very complex organ.
Why is it complex? Because an average square inch of the skin contains 650 sweet glands, 20 blood vessels and more than 1000 nerve endings.
The skin also makes up around one-seventh of a person's body weight although its tiny thickness.
So, what does the thickness of the skin consist of?
The skin has three main layers: the epidermis, the dermis and the hypodermis.
Let's talk about each layer of them separately.
Let's start with the epidermis.
The epidermis is the outermost layer of the skin. It is the layer that gives the skin its tone. It represents a waterproof barrier and plays other roles including:
- Giving the skin its colour.
- Making new skin cells.
- Protecting the body from the external environment.
The human skin has a very quick turnover rate. It sheds around 500 million skin cells each day. In fact, the upper and outermost layer of the epidermis is about 20 to 30 layers of dead cells.
The epidermis constantly makes new cells in the lower layers. And over about four weeks, these cells make their way to the surface to become hard and to replace the shedding dead cells.
The most common type of cells within the epidermis is the keratinocytes. Their main job is to form a barrier against bacteria, parasites, fungi, viruses, heat, ultraviolet rays and water loss.
The pigment we see in the epidermis layer is not because of blood vessels. In fact, the epidermis has no blood vessels.
The colour of the skin is due to a pigment called melanin. This pigment is produced by specific cells called melanocytes. Melanocytes are found in the epidermis and are the main protector of the skin from UV rays.
The epidermis, as we mentioned, is the outermost layer of the skin. But surprisingly, the epidermis itself consists of five layers, and they are:
- Stratum corneum.
- Stratum lucidum.
- Stratum granulosum.
- Stratum spinosum.
- Stratum germinativum.
At the base of the epidermis layer, there is a thin sheet of fibers called the "basement membrane", and it separates the epidermis and the dermis.
The next layer we are going to discuss is the dermis.
The dermis is another skin layer that protects the body from stress and strain because it is mainly made up of connective tissue.
It provides the skin with the strength and elasticity it needs to adapt to the surrounding environment.
- It makes sweat and oil.
- It provides blood to the skin.
- It is the layer of sensation.
- It is the layer where hair grows.
But why can the dermis do these functions while the epidermis can't?
The reason is that the dermis contains the hair follicles, blood vessels and lymphatic vessels.
It also contains the glands such as the sweat glands and the sebaceous glands that produce sebum. Sebum is the oil that lubricates and waterproofs hair.
The dermis also contains different sensation receptors, for example, it contains a receptor that detects pressure (mechanoreceptors), receptors that detect pain (nociceptors), and receptors that detect heat (thermoreceptor).
Because the dermis is a connective tissue layer, when it is stretched so much, like during pregnancy, you can see tears in it and these tears will appear later in the form of stretch marks.
The dermis is subdivided into two layers:
- The papillary region. It contains loose connective tissue. The connective tissue forms finger-like projections that extend into the epidermis. Those projections are responsible for the bumpy surface of the dermis and responsible for the person's fingertips.
- Reticular region. This layer contains dense irregular organized connective tissue. It also contains the proteins that give the skin its strength and elasticity.
After the dermis, comes the subcutaneous tissue.
It is the deepest layer of the skin. It might be also called the hypodermis or the subcutis layer.
It is not actually a part of the skin but rather a layer that helps attach the skin to the bone and muscles. It also supplies the skin with blood and nerve supply.
The hypodermis is almost made up of fat. This amount of fat helps insulate the body and prevent the loss of too much heat.
Fat acts also as a protection pad to the bones and muscles.
The hypodermis layer also contains connective tissue and elastin.
But what is elastin? Elastin is the elastic protein that helps the skin to return to its normal shape after stretching.
Those are the layers of the skin. All of them combined make the skin capable of performing many important functions, including:
- Protection against pathogens. There is a type of cell called "Langerhans cells". Langerhans cells are part of the immune system and they fight against different pathogens.
- Storing fats and water.
- Organ of sensation. The skin makes us feel different sensations through nerve endings that detect temperature, pressure, touch, vibration and injury.
- Preventing water from escaping through evaporation so it controls water loss from the body.
- Preventing the wash of necessary nutrients from the skin by providing water resistance.
- Thermoregulation. The skin produces sweat and dilates blood vessels which keeps the body cool. We also feel goosebumps when we are cold. It is one way for the skin to retain heat as well as blood vessel constriction.
But what about skin colour, why do we have different skin colors?
Skin colour differs from one person to another just like height and eye colour. Skin colour depends on different types of pigment called melanin.
Melanin is very important because its main function is to protect the skin from the damaging effects of UV light rays. UV rays can cause skin cancer sometimes.
When the skin is excessively exposed to UV light, skin cells called melanocytes start producing melanin to protect the skin creating a suntan.
There are two types of melanin pigment that affect the colour of our skin. The first type is pheomelanin. People who have more pheomelanin will have a paler skin colour. The other type is eumelanin. People who have more eumelanin will have a darker skin colour.
You may have noticed that people who live close to the equator have darker skin, which is true according to researchers in evolution. They have darker skin to protect them against the sun’s UV rays. While people who live in colder climates, evolved lighter skin to maintain vitamin D.
Vitamin D is produced when the skin is exposed to the sun. It is very important for the absorption of calcium. And that’s why females, in general, have lighter skin than males, because they need more calcium in pregnancy and during breastfeeding.
As with any organ in the body, the skin is susceptible to different diseases such as acne, dermatitis, melanoma, psoriasis, scabies, shingles, lichen planus, or keratosis pilaris.
We will focus on keratosis pilaris, we will try to understand this disease, its causes, risk factors and how it is treated.
So, first off, what is keratosis pilaris?
Keratosis pilaris is a benign skin condition. It looks like small bumps; however, it is not harmful and doesn't cause any discomfort or itching.
People who have this condition will notice small painless bumps on their skin around hair follicles. These bumps are skin-colored, so they might be white, brown or red.
Keratosis pilaris is called KB or even “chicken skin” sometimes because it has a goose-bump like appearance.
Many doctors consider keratosis pilaris a skin type rather than a medical condition. It is most commonly seen in families with a medical history of asthma, eczema or allergies.
So, why would doctors consider it a skin type?
Because keratosis pilaris is so common, many doctors think of it as a skin type. In fact, about 50% to 80% of teenagers and 40% of adults will develop these bumps at some point in their lives. You can typically find these bumps on the upper arm, buttocks, cheeks or legs.
The question is, who is more likely to develop keratosis pilaris?
It is typically more common in younger people; however, it increases and gets worse around puberty.
Babies and teenagers are more likely to develop keratosis pilaris.
Besides, keratosis pilaris was found to have a link to certain genetic traits, which makes people who have these traits more likely to develop them during their lives.
People who have these characteristics are also more likely to develop keratosis pilaris:
- Fair or light skin.
- Having certain skin conditions such as eczema or ichthyosis Vulgaris; a genetic condition where the skin dead cells look like fish scales.
- Suffering from asthma. It is an achromic respiratory disease that causes breathing difficulty due to inflammation of the airways.
- Being obese or overweight.
The condition is also known to worsen during winter months when the air is drier and so the skin dries out more, and sometimes during pregnancy.
So, are there specific symptoms of keratosis pilaris?
You will not be surprised when we say that the most noticeable symptom of keratosis pilaris is its appearance, the
The visible bumps, the groupings of tiny rough discolored bumps that appear on the skin and look like the skin of a plucked chicken.
And that's why it is commonly known as chicken skin.
Bumps appear anywhere on the skin that has hair follicles. That's why we never find them on the soles of our feet or the palms of our hands.
As we mentioned, they are mainly found on the upper arms and thighs.
Other symptoms include:
- Slight redness around the bumps.
- Itchy or irritable skin that causes the bumps to become redder and more noticeable. It is a condition known as "frictional lichenoid dermatitis".
- Bumps that appear in different colors based on the skin tone.
- Bumps that feel like sandpaper.
Some of these symptoms can be caused by other conditions that induce similar symptoms such as eczema, psoriasis, allergies, or fungal infections. That’s why it is always a good idea to check with your doctor about your symptoms.
So, what causes keratosis pilaris?
If we understood the mechanism of the disease and how those bumps form, we can grasp a better understanding of the causes.
The bumps that appear on the skin in keratosis pilaris are actually collections of dead skin cells. They can be mistaken sometimes for small pimples.
So, we can conclude that keratosis pilaris happens when dead skin cells clog the pores instead of shedding. The pores are open at the site where the hairs come through the skin from the hair follicles.
Scientists are not sure yet why some people develop keratosis pilaris while others don't, but as we explained, genetic factors may play a role and impact the chances of developing it. Some risk factors put patients at a higher risk of developing keratosis pilaris, for example, if someone has eczema, they are more likely to develop KP. Why? Because it is a chronic condition that causes the skin to have red itchy patches that appear and disappear every now and then.
That takes us to another important point. Is keratosis pilaris contagious?
From the previous explanation and the genetic factor, we mentioned you can tell that it is not contagious.
Among the many different types of skin bumps, keratosis pilaris is still a harmless condition.
So, how can doctors diagnose keratosis pilaris?
As we suggested before, it is better to always check your skin symptoms with your doctors because a variety of conditions can induce similar symptoms.
As for keratosis pilaris, your doctor will typically diagnose it with a simple physical examination. Your doctor can confirm it is keratosis pilaris just by looking at the skin of the affected area.
Investigations and medical testing are usually not needed to diagnose this condition.
However, if your doctor is not sure it’s keratosis pilaris or not, additional medical tests might be needed. One of these tests is to take a tiny skin sample to rule out other conditions that may also cause itching and skin bumps.
But doctors usually depend on the location and characteristics of the skin bumps to confirm it is keratosis pilaris.
For example, keratosis pilaris is known to be common on the upper arms, cheeks, legs or buttocks.
And how the skin bumps look and feel will give your doctor a clue whether it is keratosis pilaris or not.
Keratosis pilaris bumps are known to be:
- Painless, so if you feel discomfort or pain when you press on the skin bumps it is mostly not keratosis pilaris.
- Itchy or dry. In keratosis pilaris, the bumps and the skin around them might feel itchy and dry.
- Rough. If you touch the area that has the skin bumps of keratosis pilaris, you will feel it is rough like sandpaper.
- Discolored. Bumps may appear discolored according to the natural colour of the skin.
But does keratosis pilaris need a specialist to diagnose?
In most cases, your family doctor can diagnose keratosis pilaris. Some people might prefer going to a dermatologist for treatment of keratosis pilaris.
But what about toddler keratosis pilaris? Do they also need a dermatologist to treat them?
Just like adults, children can have colored skin bumps anywhere on their skin but mostly on their cheeks, arms and thighs.
Parents usually notice those bumps more in winter. But overall, the bumps come and go. They often disappear when the child gets older.
If there is a family member, especially a first-degree family member, that has keratosis pilaris, it can be passed down to the children.
And likewise in adults, keratosis pilaris is more common in children who have asthma, eczema, hay fever or other skin problems.
Follow-up is the key to your child’s safety. Always consult your child’s pediatrician about any suspicious condition. The pediatrician can diagnose it and if he or she can’t, he or she will refer your child to a specialized dermatologist.
So, how is keratosis pilaris treated in adults and children?
If keratosis pilaris is bugging you, the first thing you might think of is to grab a loofah and start scrubbing.
But be careful, abrasive scrubs can trigger your body to produce more of the protein that causes keratosis pilaris.
So, how can you get the smooth skin you dream of?
First of all, let me tell you this. Some doctors think that because keratosis pilaris isn’t harmful, it doesn’t need treatment. And their argument is explained by the fact that bumps might go away and disappear on their own by the time you are 30.
But after all, it is up to the patient. If the bumps are bothering the patient, then, there must be a treatment.
Treatments that your family doctor or your dermatologist might recommend include:
- Moisturizing lotions. Because dryness can make keratosis worse, your doctor will recommend keeping your skin well moisturized and hydrated. So, applying an over-the-counter moisturizer will do. Creams that contain alpha hydroxy acid, lactic acid, salicylic acid or urea can loosen and remove dead skin cells. They will also moisturize the skin. These creams are considered topical exfoliants. Depending on their strength, your doctor will recommend the best option for your skin condition and how often to apply it. The acids in these types of creams can cause redness, skin tingling and irritation, that’s why they are not recommended for young children.
- Medicated creams. Your doctor might prescribe you certain types of medicated creams such as creams that contain urea and alpha hydroxy acid. Medicated vitamin A cream can also help to prevent the build-up of dead skin cells that cause keratosis pilaris. However, you should be careful when you use these creams because they might cause skin irritation.
- Exfoliating. Your doctor may also recommend using a loofah to gently brush the area with keratosis during the shower. But as we mentioned, make sure not to brush too hard because it will make the condition worse.
- Laser treatments. You will find laser treatment at dermatologists’ clinics. The laser can improve the redness associated with keratosis pilaris.
Aside from medicated creams and over-the-counter moisturizing lotions, some patients’ skin felt better when they changed their skincare routine to avoid dry skin. Those changes include:
- Shorten the shower length. Taking shorter showers that last up to 15 minutes or less.
- Using moisturizers daily.
- Using a humidifier to keep the skin hydrated.
- Using warm water during showers.
You have to keep in mind that keratosis pilaris treatments aren’t temporary. You will have to continue using them to see continued improvement.
But after all, keratosis pilaris isn’t a harmful skin condition, it is rather an ongoing skin condition. That’s why some people find no benefits of treatments.
As for children, here are some of the recommended tips to take care of your child’s skin:
- Use a gentle soap or cleanser that doesn’t dry your child’s skin.
- Use a mild over-the-counter skin moisturizer on your child’s skin. A product with urea, lactic acid or salicylic acid will be fine.
- If your doctor prescribes your child a certain cream or a certain medication, use it as directed.
- Call your doctor if the condition is getting worse or if an infection happens.