Keratosis Pilaris

Keratinisation Disorder ICD: L11.0

Also known as: KP, Chicken Skin, Follicular Keratosis

Description

Keratosis pilaris is a very common benign condition caused by excess keratin plugging hair follicles. It presents as rough, skin-coloured or erythematous papules, typically on the upper arms, thighs, cheeks, and buttocks. It affects up to 40% of adults and is more prevalent in those with atopic tendencies. While harmless, it is a frequent cosmetic concern.

Symptoms

  • Small rough papules ("goosebump" texture)
  • Skin-coloured, red, or brown bumps
  • Upper arms, thighs, cheeks, buttocks — typical distribution
  • Dry or rough skin texture
  • Mild pruritus (occasional)
  • Worsens in dry/cold weather

Causes & Triggers

  • Excess keratin production plugging follicular ostia
  • Associated with atopic dermatitis and ichthyosis vulgaris
  • Genetic predisposition (autosomal dominant, variable penetrance)
  • Exacerbated by low humidity and dry skin

Severity Classification

Mild Scattered papules, barely noticeable, minimal roughness
Moderate Widespread papules with erythema, rough texture, cosmetic concern
Severe Extensive involvement with significant keratotic plugging and inflammation

Treatment Ladder

  1. 1 Foundational: Regular emollient use to reduce dryness
  2. 2 Mild: Keratolytic moisturisers (urea 10%, lactic acid, salicylic acid)
  3. 3 Moderate: Topical retinoids (tretinoin, adapalene) for follicular normalisation
  4. 4 Moderate: Glycolic acid or lactic acid chemical exfoliation
  5. 5 Refractory erythema: Pulsed dye laser for redness

Relevant Compounds

Adapalene

Retinoid — reduces follicular plugging

Adapalene is a third-generation synthetic retinoid that selectively binds to RARβ and RARγ receptors…

Ceramides

Barrier support in atopic-prone skin

Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…

Glycolic Acid

AHA — exfoliates and smooths rough texture

Glycolic acid is the smallest alpha hydroxy acid with the greatest bioavailability due to its low mo…

Hyaluronic Acid

Humectant to maintain hydration

Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…

Panthenol

Soothing and moisturising agent

Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…

Retinol

Normalises follicular keratinisation

Retinol is an over-the-counter retinoid and a precursor to retinoic acid (tretinoin). It must be con…

Salicylic Acid

BHA keratolytic — dissolves keratin plugs within follicles

Salicylic acid is a lipophilic beta hydroxy acid with keratolytic, comedolytic, and mild anti-inflam…

Recommended Drugs

Differin Adapalene gel for stubborn KP (off-label use)

Suggested Cosmetics

AHAGlow Advanced Face Wash Gel Glycolic acid for mild surface exfoliation Deconstruct Pore Control Serum — 2% Salicylic Acid + 3% Niacinamide BHA exfoliation for keratotic plugs The Derma Co 2% Salicylic Acid Face Serum BHA for follicular unclogging Dot & Key 10% Glycolic Acid Glow Serum Glycolic acid for surface exfoliation Minimalist 2% Salicylic Acid Serum Salicylic acid for follicular unclogging Re'equil Ceramide & Hyaluronic Acid Moisturiser Moisturiser for KP-prone dry skin

Lifestyle Tips

  • Apply keratolytic moisturisers consistently — results take 4–8 weeks
  • Avoid scrubbing or picking at bumps (worsens inflammation)
  • Use lukewarm water — hot showers strip skin oils
  • Exfoliate gently with a washcloth, not abrasive scrubs
  • KP often improves with age and in humid climates
  • Set realistic expectations — managed, not cured

When to Refer

  • Extensive or atypical presentation needing differential diagnosis
  • Significant associated erythema suitable for laser therapy
  • Suspected ichthyosis or other keratinisation disorder