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  Keratosis pilaris

Keratosis pilaris (KP) is characterized as a genetic follicular skin condition that manifests as rough bumps on the skin hence; the colloquial term is referred to as "chicken skin". These typical lesions are commonly confused with goose bumps seen when the arrector pili muscle underneath the skin contracts. Keratosis pilaris is also often confused with acne vulgaris. The reason for its pathognomonic appearance is because the skin cells that normally flake off from the skin form plugs in the hair follicles. Therefore, they appear as small pimples or usually white, but sometimes red-colored papules, having a dry ''sandpaper'' feeling. Most people with this condition do not even know that they have this skin condition. Common sites of distribution of the lesions are at the back and outer aspects of the upper arms, but can also occur on the thighs and buttocks or any other body part except in the palms or soles of feet.

Keratosis pilaris Skin diseases
Keratosis pilaris

The incidence rate of keratosis pilaris is approximately estimated to be at around 40 to 50% of the adult population and 50 to 80% of all adolescents worldwide. Women are predominantly affected more than men. Keratosis pilaris is particularly more common among teenagers and often seen on the upper arms. In babies afflicted with this skin disease, it is seen mostly on the cheek area. The disease may persist for several years but generally it disappears gradually usually before age 30. Some cases, however, will have keratosis pilaris for life.

There are varying degrees as to severity of keratosis pilaris cases, ranging from mild to severe condition. Some severe cases are attributed by scratching and picking at bumps causing redness, swelling, and even increase in number. In some cases, bleeding and scar formation may occur.

The different types of keratosis pilaris include: keratosis pilaris rubra (red, inflamed bumps); keratosis pilaris alba (rough, bumpy skin without any irritation) and ; rubra faceii (reddish rash on the cheeks).

The pathophysiology of keratosis pilaris lies on excessive keratin production. Keratin is a natural skin protein, produced by the keratinocytes (the most abundant epidermal cells). Keratin tends to accumulate around hair follicles, a process known as hyperkeratinization bringing about the rough, small but hard bumpy lesions proliferating in the affected skin surface. Nevertheless, the lesions are seldom itchy or sore and harmless but it is unsightly with aesthetic consequences. The condition usually exacerbates and more pronounced in its color and texture during the colder months and in times when the humidity is low. This is due to the fact that the skin dries out in the aforementioned weather conditions. Pregnancy or after childbirth can also make this follicular skin condition worse.

There is no known cure for keratosis pilaris hence; any treatment is not necessary. The goal of pharmacologic treatments is just symptomatic relief and must be repeated to obtain satisfactory improvement. Initial treatment include use of intensive moisturizing creams (e.g. Retin-A, lac-hydrin), and medicated lotions containing alpha-hydroxy acids or urea. The purpose of this initial treatment is to temporarily improve the appearance and texture of the rough bumpy skin. If this fails then shift to a medicated cream containing urea (Curel, Carmol-20) or alpha-hydroxy acids (Aqua Glycolic, Lacticare) which is applied two times a day despite its rather irritating effect once used more often. For those who can tolerate, a more aggressive home treatment can be done by taking longer, hot soaking tub baths while simultaneously rubbing the affected skin with a coarse washcloth or stiff brush to remove the plugged follicles.

Some antibiotics such as Erythromycin and Bactrim are prescribed especially if the spots are very red. Another alternative is the use of Tazorac cream, a vitamin-A type of drug that causes irritation in some people. To reduce the marks and avoid repeated scratching of the bumps around the affected areas, wearing tight-fitting clothes or jeans is not advisable, you can wear loose clothes instead.

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