Keratosis Pilaris

Dr. Greene, my 4-year-old son has this rash on the backs of his arms that looks like a dry form of goosebumps. It never goes away and is skin color or light pink. I have had the same rash on the fronts of my thighs and backs of my arms my entire life. It doesn’t itch and doesn’t bother us. Is it a vitamin deficiency or a hereditary skin condition?
Wendy Rinas – Ferndale, Washington

Keratosis Pilaris

Dr. Greene’s Answer:

Wendy, the rash you describe sounds like keratosis pilaris, a common mild condition in which the backs of the upper arms look rather like dried out, plucked chicken flesh. If this is the case, half of your son’s children are likely to have the same future in store for them (unless your grandchildren’s mom also has it, in which case about 3/4 of the grandkids will). Keratosis pilaris is hereditary. Wendy, this is yet another way that you are linked to your son.

The characteristic rash is caused by firm little plugs forming in the hair follicles. The plugs themselves are made of bits of keratin, the main protein found in the outermost protective layer of skin (thus the name keratosis). These plugged follicles give the skin a raised, stippled appearance — usually called goosebumps. The bumps are usually skin color or slightly pinker, and do not itch. The rash is often not noticeable to others, except on close inspection.

Classically the condition appears in early childhood, often around the age of two or three. Since the rash is associated with and worsened by dryness of the skin, most people experience a clear-cut seasonal variation — generally worse in the winter. Although the rash changes in intensity from time to time, the baseline usually stays the same until middle adolescence, when it begins to improve. Adults who still have keratosis pilaris often experience further improvement during the middle decades. The average age when spontaneous improvement is first noted is sixteen (British Medical Journal, June 1994).

Although keratosis pilaris is hereditary, the rash is more common in those with eczema, dry skin, or vitamin A deficiency (or a number of more esoteric skin conditions). The most common spot on the body for keratosis pilaris is the backs of the upper arms (92% of affected people have it there). Next most common is the thighs (59%) (British Medical Journal, June 1994). It can also occur on the face, buttocks, and eyebrows.

Since the rash is often neither unattractive nor bothersome, treatment is entirely optional. The simplest treatment is to keep the skin moist with the frequent use of moisturizers, particularly just after the skin has become wet. Increasing the humidity in the sleeping quarters has also been shown to improve the rash (Clinical Pediatric Dermatology, Saunders 1993). Gentle exfoliation with a body scrub, loofah sponge, pumice sponge, or even a washcloth, can help loosen the plugs.

Also be sure that you and your son get adequate amounts of vitamin A in your diet, and perhaps from a vitamin supplement. Don’t overdo it on the supplements, however, since it is possible to overdose on vitamin A.

If further treatment is desired, your doctor can discuss adding an acid (urea, lactic, glycolic, alpha-hydroxy, or salicylic acid) to a moisturizer. This combination can be quite effective. You might have to experiment to find the optimum concentration of acid for you and your son (often different), to decrease the keratosis without irritating the skin. Ureacin is a strong, urea-containing moisturizer that often works quite well, and comes in different strengths.

The same manufacturers also make Lazer Creme, a gentle, natural moisturizer formulated for keratosis, and containing both vitamins A and E. (On the opposite extreme, chemotherapeutic agents used to treat cancer have as one of their few slightly positive side effects that they improve or eliminate keratosis pilaris — obviously not worth it as a treatment).

I like the idea, though, of using topical retinoic acid (Retin-A). This common medication used for the treatment of acne (and of wrinkles) should combine the benefits of both vitamin A and a gentle acid. I haven’t been able to locate a research study supporting its use, but we do know that the rash contains receptors to retinoic acid (Dermatologica, 1986) and that oral retinoic acid works (Cutis, April 1980) — although usually the risks outweigh the benefits of oral use.

Whether you choose to try some of these treatments or do nothing at all, when you and your son gently rub your hands over the backs of each other’s arms you can feel your connectedness. Your DNA, the distillation of who you are, is linked to his — a connectedness that links both of you to past and future generations of your family. Your life continues on in him, just as you carry your parents forward into this generation. Perhaps the keratosis pilaris will remind you to notice this connectedness even in situations where the link itself is invisible.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. claudia1771

    I have what I think of this condition on both of my arms. It’s ugly, itchy and annoying! I have gone to the dermo and allergist and nothing had helped! I wish there was something to take it away!!!

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  2. Christine

    My daughter had iron deficiency at 7 to 8 months which the doctors missed even
    though I kept asking them to check her iron. Then at around 13 months her iron
    stores still weren’t increasing well even with high dose of iron supplement.
    She then developed severe rotavirus at 14 months even though she’d been
    inoculated, and was in hospital for a week. Prior to this she developed
    keratosis pilaris on one arm and cheeks. She is dairy intolerant and wasn’t
    getting a vitamin supplement because I was concerned about too MUCH vitamin A,
    she also had a very small appetite and is breastfed. I then read up about an
    association between severe rotavirus and vitamin A deficiency, problems with
    iron absorption due to vitamin A deficiency and Keratosis pilaris and vitamin A
    deficiency so went to various doctors to try and get her tested. None of them
    had ever done the test before and thought I was over reacting and nothing wrong
    with my child (same as when I kept asking about her iron). I then had to
    increase her vitamin A blind as I didn’t realise I could get a vitamin A test
    done without going through a doctor. After a couple of months her rash has all but disappeared and her iron
    stores have increased rapidly and I just know she is very healthy. I also tested
    her lead levels as I live in South Africa (couldn’t get the docs to agree with
    this either). Currently they are a 4. I’m moving from an old building on the
    highway but was wondering if her levels would have been much higher when she
    was iron deficient if she wasn’t crawling at that stage? Do you have any other
    nutrition points to optimise her brain and personality development as I want to
    help her as much as possible after I let her become iron deficient! I stopped
    the omega oil I was giving her as I don’t know if I can trust the amount of
    lead in them. Is there an american brand I can buy online where they ensure low
    levels? Sorry, crazy obsessive mother, it happens when you realise you can’t
    trust your doctors and that your child suffered for months because of it. L

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  3. Alan Greene

    Samantha, patches of skin-colored goosebumps can certainly be keratosis pilaris, described in this article. There are other conditions, such as some types of folliculitis, that might also look like this. If it’s bothersome, a dermatologist or other physician would likely be able to tell by examining you.

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  4. samantha k

    i have random patches of goosebumps that come and go. it doesnt have a weird color its just like regular goosebumps but in patches, and they dont stay. some times they hurt a little bit but not bad. what could this possibly be, i would really like an answer because ive been searching and cant find a good response.

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