A distraught bride-to-be came in for consultation. She was very concerned with the appearance of goose pimples on her arms as she planned to wear a strapless gown on her wedding day. The same skin condition also exists on her thighs and she was embarrassed about wearing a bathing suit on her honeymoon.

The medical term for this condition is keratosis pilaris (KP). KP is a very common disorder affecting many people of all ages throughout the world. KP is usually found on the outer aspect of the arms, elbows and thighs and usually appears as numerous small, rough, flesh colour or dark bumps around the hair follicles. It can, however, affect the rest of the body except for the palms and soles. KP is often described as goose bumps, chicken skin or pimples. Generally, KP is medically harmless, but cosmetically displeasing as well as psychologically distressing for most patients; and because of this they seek treatment to clear the unsightly appearance of this skin condition.

Keratosis pilaris is a genetic disorder of keratinisation (skin cells formation) of the hair follicles. An excess formation and/ or buildup of keratin (skin cells) in and around the hair follicles give the “goose bumps” appearance on the skin. These coarse bumps also give rise to the abrasive sand paper texture of the affected areas which is unpleasing to the touch for both patients and their paramours. Sometimes a hair is unable to reach the surface due to the excess skin cells blocking the exit of the hair follicle. This results in inflammation (redness) and itching of the areas. In dark-skinned individuals, the irritation causes the melanin factory to produce excessive melanin resulting in dark spots around the bumps, worsening the appearance of the already unsightly condition. Fortunately, not all the bumps have associated hairs underneath. Patients often scratch these bumps which may introduce bacterial infection and result in a rare complication which produces cysts, with or without abscess formation.

Keratosis pilaris affects people of all races and occurs in both sexes. KP may exist with other dry skin conditions such as atopic eczema. KP often becomes more exaggerated in the teenage years, during pregnancy and in obese individuals which may imply a hormonal association. In some patients, KP worsens when they are in a cold, dry climate as evidenced in those who attend schools in the cold countries (eg: US, Canada and UK). While some patients have lifelong KP with periods of remissions and exacerbation KP tends to improve with age.

Management

Many patients have very good temporary improvement following a regular skincare programme. As a general rule, treatment needs to be continuous. Exfoliation and lubrication is the mainstay of treatment.

• The affected area may be washed with an exfoliating cleanser such as ariSulfur bar.

• Lotions should be massaged into the affected area at least 2-3 times a day. These lotions should contained chemical exfoliants which include urea cream (ureativ, Uremol), lactic acid lotions (Amlactin, Lac-Hydrin) and lotions with salicylic acid or glycolic acid.

• If the skin is irritated or abraded , the area should only be treated with bland moisturiser (Cetaphil cream , Vaseline petroleum) until the inflammation resolves.

• See a doctor/dermatologist if the inflammation persists or if there is infection or abscess formation.

• See a dermatologist if the above home treatment proves inadequate. In office treatment such as glycolic, salicylic and lactic acid peels are used with very good result. Dermabration is another safe and effective method used with good result. The above procedures are followed by a prescribed compound cream of combined exfoliants for use at home.

• Persistent dark discolouration may be treated with a special compounded “fade”cream prescribed by your dermatologist. After initial clearing with the stronger medication, patients are then placed on a milder maintenance regimen.

Dr Patricia Yap is a dermatologist at Apex Skin Care and Laser Center E-mail: apexskinclub@gmail.com