Those Rough and Bumpy Arms and Legs

Guide to the Management of Keratosis Pilaris

What does KP look like? This annoying skin disorder, called keratosis pilaris (KP), is characterized by thousands of hard, non-inflammatory keratin plugs that cover the hair follicles, making the skin rough and pebbled, in appearance and to the touch. And, it worsens dramatically if picked and scratched. Skin tampering invites secondary infection, enlargement of the bumps, delayed healing and unsightly discoloration. These dark, discolored sores mimic burned-out acne and can cause permanent scarring.

Does KP look different on People of Color? Yes. On many black, Hispanic, Asian and dark or olive-skinned people, KP resembles thousands of tiny blackheads and dark blemishes blanketing the skin.

What parts of the body are affected? The backs of the arms, the shoulders, the front and sides of the upper legs, the calves, the buttocks and occasionally on the cheeks of small children, though its not limited to those areas.

What causes KP? Though KP has been blamed on everything from shaving to tight jeans to dry skin, keratosis pilaris is a chronic, genetic condition caused by hyperkeratosis, the build-up of dead skin cells that cover the follicle opening.

Is there a cure for KP? No. Though KP can be controlled, the can bumps return shortly after abandoning treatment. While there is no lasting "cure”, consistent home management can keep those bumpy symptoms in check, lessening the risk of hyperpigmentation.

What can I do to treat my KP? Gentle, twice daily use of natural bristle body brush with an alpha hydroxy acid, sulfur or benzoyl acne soap or cleanser can sometimes solve the problem. Keratolytic topicals like sulfur/resorcinol lotion, benzoyl peroxide (BPO), glycolic or lactic acid gel or lotion, potent Retin-A® can all be highly effective with regular use. Since 1989 most health insurance carriers won’t cover Retin-A® prescriptions for adult patients over 26 years of age; the large amount of Retin-A® needed to keep keratosis pilaris under long-term control make its use financially prohibitive.

My KP seems to improve when I get a lot of sun. Why? Sun exposure causes mild burning and subsequent peeling (similar to BPO, Retin-A®, AHA, BHA, etc.) that temporarily exfoliates KP bumps. But, the sun also darkens bumps on People of Color and causes premature aging, the destruction of skin texture, unsightly sun spots (keratoses), sagging of the skin and skin cancer.

How do I use these exfoliating products? Since keratosis pilaris most frequently affects the non-sensitive areas of the upper arms, thighs and buttocks, topical exfoliating products may be used daily in the absence of skin irritation. Product potency and the daily application schedule should be evaluated and varied according to individual skin sensitivity of those areas and other affected body parts.

What if my KP is red in appearance? Some light-skinned KP sufferers get a non-inflamed form of “red” KP characterized by thousands of tiny rough red bumps. Others have an inflamed KP condition that resembles active acne and larger lesions, often caused by picking. Cleansers and topicals containing benzoyl peroxide (BPO) and/or sulfur, which are both anti-bacterial exfoliants, work well on all red and/or inflamed KP. Keep in mind that it bleaches fabric and must not be worn if one expects to perspire or be exposed to the sun. It works best when worn on the affected area at bedtime, followed by clean white T-shirts and/or pajamas.

What if the KP is bumpy but not inflamed? Alpha hydroxy acid (glycolic or lactic) lotions or gels (10% to 15%) can be applied sparingly once or twice day, and rubbed thoroughly into the skin until all traces have been absorbed. Unlike benzoyl peroxide, alpha hydroxy acid (AHA) won’t discolor fabric. For non-inflammatory and post-inflammatory cases, alpha hydroxy acid lotions and gels can be applied sparingly in the absence of irritation.

What if my KP bumps are much darker than my skin tone? Sometimes, KP looks like a sprinkling of blackheads, especially on People of Color. Formulations containing alpha hydroxy acid (glycolic or lactic) formulated with lighteners and brighteners along with bleaching soaps can work wonders on KP that is a much darker brown than the surrounding skin. Hydroquinone (HQ) must be allergy patch-tested for three days prior to use unless you have used skin lighteners containing HQ without adverse reactions in the past. Body exfoliants containing AHA and formulated with hydroquinone and skin brighteners are designed specifically for use on hyperpigmented skin if direct sun is avoided and full-spectrum sunscreen is used religiously.

How do skin lighteners fade the spots caused by KP? These products work three ways. First, alpha hydroxy acid softens and exfoliates the buildup of keratin (dead skin cells) that buries the hair follicle. Next, it acts as a “vehicle” to carry skin lighteners and brighteners deeper into the follicles. Last, skin lighteners help inhibit the over-production of dark melanin coloration in the basal layer of the epidermis, but need a vehicle with a small particle size to penetrate deep enough to be effective. Lighteners and brighteners include hydroquinone, kojic acid, mandelic acid, arbutin, bearberry extract, mulberry extract, azelaic acid, licorice root extract, l-ascorbic acid, vitamin K, lemon and lime extract, and others. These ingredients perform best when formulated with a “penetrant” (like AHAs and retinoids) that allows these melanin-suppressors to penetrate the follicle.

Can I go into the sun after the KP clears up and my spots fade? If your skin is exposed to any direct sun at all, it is important to apply full-spectrum sunscreen hourly. Try to make every effort to avoid the sun whenever possible. This is especially important if any discoloration is present, or if your skin blemishes have a tendency to over-darken. Previously hyperpigmented skin can darken faster than the surrounding skin, even after the spots have faded and the KP is under control. Keep in mind that a variety of health problems and medications can make your skin extremely sun sensitive and total sun avoidance is advisable.

What are the side effects of these treatment products? The side effects of the treatment for keratosis pilaris can include temporary dryness, mild peeling and itching and the presence of superficial darker patches of dead skin cells. These symptoms subside as the skin gets used to exfoliating lotions and gels, and if they are used exactly as directed. Overuse will worsen or prolong these symptoms.

Can scrubbing help my KP? Gentle exfoliation in the absence of irritation can help keep the KP-affected skin smooth. Excessive pressure, rough scrubbing and picking are taboo. They increase the risk of uncomfortable side effects, irritation, sun sensitivity and dark discoloration.

Are any treatments available to boost my efforts? Professional glycolic and lactic acid peels, the absence of irritation, can be useful in boosting stubborn cases.

Can I stop treatment after I clear up? No. Keratosis pilaris is a chronic genetic condition with no permanent cure. Home maintenance must be continued permanently to prevent the bumpy or symptoms from recurring.

2001 Kathryn Leverette, Solutions Center, Kathryn Leverette, Inc.

Thanks for the information. That pretty much sums up KP and gives good advice on how to treat it. Atleast it didn't say that KP clears up with age which I've read so many places and it's simply NOT true

I have a problem popping my KP bumps and this article taught me that doing this can actually worsen the condition by causing a "secondary infection". I had heard that picking causes more bumps but didn't really beleive it. But this now makes sense and hopefully this little fact will help me to quit picking (popping) for good.

I learned something new. Thank you again!

Ashley

What would some suggested products be & where could I find them? You mentioned "alpha hydroxy acid, sulfur or benzoyl acne soap or cleanser...Keratolytic topicals like sulfur/resorcinol lotion, benzoyl peroxide (BPO), glycolic or lactic acid gel or lotion, potent Retin-A®"

I can testify to the fact that popping the bumps is a surefire way to cause the bumps to spread. When I was a teenager, I had only a few bumps on my upper arms and cheeks, until I started picking at them. Slowly but surely, the bumps started to spread and get worse and worse. Now I have KP on my upper arms, forearms, thighs, and a few bumps on my calves and sides and stomach. I stopped picking at my face several years ago, and now the bumps are mostly gone, but the skin on my cheeks and eyebrows gets red. Anyway, whenever I stop picking at an area, it starts to clear up. My forearms are WAY better now that I have been leaving them alone. I am trying to enough self control to leave the rest of my skin alone! We all need to be kind to our skin!

this was very helpful and informative.

thanks for the info.

I posted my story of how picking worsened and spread my KP and someone replied saying that can't happen. I didn't think I was crazy. I'm sure that my former chronic KP picking habit has resulted in the unsightly, inflamed KP that spread all over most of my upper arms. I believe that if I had never picked, my KP would be alot less noticeable today than it is now. Self control is so important.

Stella, I agree with you. For years I picked at my legs. And the one site where I picked and plucked....Well it looks bad.

hi, i have had keratosis for a while now, on my arms, thighs, face, and a few on my lower legs. it has been incredibly embarrassing for me to show these targets in public, but i have news for you! last night, i used a loofah (a plastic colored loofah, not those fiborous tan ones). i scrubbed up in down first with body wash, following another scrubbing session without body wash. i was fairly gentle. after i got out of the shower, i put TONS of lotion everywhere. this morning i was eager to see the results, and i looked on my arms and the results were great! my legs and thighs were so/so, and i didnt do the scrubbing on my face due to the fear of redness. they didnt take care of the problem, but they definitely suceeded in smoothing the bumps and making them less noticable. im thinking, "if this is what they look like now, i wonder what they will look like in a week, or even a month?!" i hope you try this because my dermatologist agrees that gentle scrubbing helps. ONE THING TO REMEMBER: wait about 5-10 minutes in the shower before you start to scrub, because the water needs to soak in to your skin for gentle scrubbing.

hi, i have had keratosis for a while now, on my arms, thighs, face, and a few on my lower legs. it has been incredibly embarrassing for me to show these targets in public, but i have news for you! last night, i used a loofah (a plastic colored loofah, not those fiborous tan ones). i scrubbed up in down first with soap, following another scrubbing session without soap. i was fairly gentle. after i got out of the shower, i put TONS of lotion everywhere. this morning i was eager to see the results, and i looked on my arms and the results were great! my legs and thighs were so/so, and i didnt do the scrubbing on my face due to the fear of redness. they didnt take care of the problem, but they definitely suceeded in smoothing the bumps and making them less noticable. im thinking, "if this is what they look like now, i wonder what they will look like in a week, or even a month?!" i hope you try this because my dermatologist agrees that gentle scrubbing helps. ONE THING TO REMEMBER: wait about 5-10 minutes in the shower before you start to scrub, because the water needs to soak in to your skin for gentle scrubbing.

Nothing makes me crazier than when I hear people say it "spread". Perhaps I'm overly sensitive, (I used to hear people say that poison ivy was contagious while gazing in horror at my puffy face and being unwilling to touch me for fear of "catching it". My mother-in-law refused to touch my first newborn son because she had a poison ivy rash and didn't want to "give it to him". *rolling my eyes* As a child who frequently suffered from severe poison-ivy reactions and the frequent need to visit the doctor due to them, I even argued with adults about how wrong that was. I mean, come on... it's an allergic reaction! If allergies were contagious we'd all be walking around with hayfever and life-threatening peanut and seafood allergies! LOL Ahem.. sorry.. getting off the track here..) Anyway...

I know it can seem that way, but the mechanisms that create the overproduction of keratin that causes Keratosis Pilaris in those areas, comes from within the body and does not spread. It usually worstens at puberty and so it may be that it appeared to coincide with the "picking". The increase in pubescent hormones ramps up the production of sebum and sweat in the pores and changes the type of hair that grows from follicles in certain areas. The purpose appears to be to feed and humidify the bacteria that grow naturally in our skin, in order to... (are you ready for this?) increase our "odor" output. Sounds gross I know, but it's still very true. The primal beast in all of us is still trying to get noticed through scent. Hence, the increase or sudden appearance of the other bane of our skin, acne.

Yes, picking does exacerbate the problem and if the surrounding area is bruised and irritated by picking, and all that plentiful bacteria finds a way into tiny openings in the neighboring follicles/pores, they may become inflamed. That only means the inflamation got worse. The Keratosis Pilaris was there right along and was just responding to the stimulation.

Most people I know who have it find that there are times in their lives, just as in mine, where there seems to be a sudden worsening or improvement of their symptoms. Stessful situations and changes in environment, hormonal changes such as puberty, pregnancy or menapause can affect it too. I grew up with it on my upper arms only, as did my siblings. After the birth of my last child it appeared on my thighs, back, buttocks and sides. My dermatologist tells me that major hormonal changes can trigger eruptions in other areas. Because I was pregnant (or nursing) constantly for 7 years, it was held at bay. Afterward..? BLAM-O!!!

I think most of us are well aware in this day and age that the old-wives' tale that states that 'the first time we shave off our hair it becomes more coarse or grows faster', is not true. It only seems that way. The hair grows the way it grows. The follicles clog the way they clog. The Keratosis Pilaris is there whether it's inflamed or not and absolutely nothing we do on the outside can effect the area the condition covers... only the inflamed appearance of it. At the very most, we "manage the symptoms".

My two cents... -Laura

I agree Laura, I don't think KP actually spreads either. I have never had it anywhere other than my arms, legs and face and that's the way it has always been. I think it's true that picking leads to more inflammation which is why it appears to get worse, because you're spreading around the bacteria. But it's kinda like how if you have a scab and you pick at that, and it gets all infected, it's gonna look worse right?

I figure our skin is one organ so if we have KP in some places it probably does exist everywhere, it just doesn't get inflamed everywhere. If the bumps and redness develop in other areas it probably has to do with some imbalance from the inside.

Any advice on how to stop the picking? I've been diagnosed with compulsive skin picking (part of the OCD spectrum) which obviously makes my KP look grotesque. My arms and calves are so spotted with dark scars and sores that I'm starting to refer to myself as leopard woman. Shaving and tweezing leads to ingrown hairs, which I also pick.

I'm taking an antidepressant and antianxiety drug as well as learning breathing and delaying techniques. However, the picking continues. I am aware of all of the treatments for KP, but most are out of the question for someone with open sores. HELP!!

Re "spreading" ...
Doubt if anyone here actually thinks KP "spreads" in the sense of "being contagious." I suspect at least some other people beside sme tend to use the word "spreads" merely because we don't know any other term for what's happened with us personally. Except maybe "shows up elsewhere" -- is that perhaps more acceptable?

I didn't even know I 'had' kp until some 5 to 8 years ago when it er "showed up" in one place then gradually began to um "show up elsewhere" ... lol... ... Certainly didn't think it was anything like "contagious" even before I started doing a little research on my own & also consulting PCP & derm, who both agreed yep KP [[ btw, because of the way it looks, flesh-ish to white-ish colored bumps or roughness mainly on upper arms & lower legs, I suppose it's what's called here the 'alba' type, although neither of my dr's mentioned that, just called it KP).

No doubt most of us know by now that KP is quite insistently said by physicians to have a genetic component, or a familial link -- so that what happened to me doesn't necessarily mean the KP (or the potential for it) wasn't there all along -- merely that something, somehow, whether internal or external or BOTH, must have kept it "managed" or "at bay". I kinda-sorta suspect what it was, or at least part of what it was; too bad I can't figure out how to bottle it, huh!

a good way to stop the picking is to (a) cut your nails very short, and (b) put lots of slippery lotion on your skin. With short nails and slippery skin, you'll have great difficulty trying to pick.

Thanks GhM. I'll try it.

Peace and good health to you!