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

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.

Last medical review on: February 18, 2012
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

I have thought I was crazy …but my hair just rapidly grows when I eat or do certain things ..u can see the hair flying of me literally..head is scabbed up and my feet and hands have excess skin it gets so hard and so much….
Has anyone experienced the hair literally growing so rapid it just fly’s right off?

My Daughter has had bumps on her thighs and upper arms since she was a little girl, from a teenager she stared getting dry bumps on her fore head, these just looked dry but now she has 16, and i can say that in the last 5 months they have been getting worse, her face is covered in bumps and acne like spots, she says her face isn’t sore but it looks it, i feel so sorry for her cause she has never suffered from acne before, we are going to the doctors next week, as i think its a hormone imbalance, but who knows, she does have issue with milk, and she has taken milk out of her diet, for a while soya milk seen to improve her bumps on the fore head, but now its got 10 times as worse, thats why i think its hormone related too, has anyone got any suggestions of what face products to use, its her prom in June and i want her to get her confidence back!!

Keratosis pilaries ka ilaz

My daughter and I both have/had this. It has completely gone away since starting a gluten free diet. As long as we stick to gluten free the bumps stay away.

That is very interesting. Have you seen any other results of the gluten free diet?

My son is 14 months old and I just noticed he was covered in goosebum like rash literally head to’s on his face, under the chin and neck is where you can feel it the most, his shoulders, back, stomach..even legs. He does have dry patches of eczema on his elbows. I thought it was a soy allergy because I started giving him soy milk like about 10 days ago and different grains but his pediatrician said it’s just dry skin that’s worse in winter. He is still breastfed and I still give him vitamin D drops and he refuse to take his iron drops. I’ve never seen this on him. I give him a bath every night and cover him up with coconut oil. We also use Mustela products only (since birth). We live in Missouri and it’s in the 20’s here these days ( very cold winter) so I’m going to turn out humidifier on again. I’ve been using the same laundry detergent since he was born and wash all of our clothes and sheets in the same detergent. Currently I’m using almond baby cream and raw coconut oil. I don’t know what else to do or if this could be something that could potentially get worse. Like I said, I’ve never experienced this with his skin and this is his second winter. Please help.


One worried mommy

This sounds exactly like my son – did it get better? Any tips?

Thank you for such a clear concise article on something I have had all my life. I have managed and won over this skin condition at varied times in my life. I also have Lupus and eczema as well as rheumatoid arthiritis. I noticed that the year I was on Methotraxate for the Lupus my KP was gone completely, unfortunately due to side effects I had to stop this medication. I am dedicated to help people find a solution to their keratosis Pilaris And have a page on Facebook in which I post any internet article and some of my wrting on this subject, I also have a Pinterest board, I find many people have this condition and are searching for answers and support I am not a health professional so I’m just sharing information and experience. I have changed to a Paleo diet at my Dr’s suggestion, stopped all dairy and sugar, take vitamins and eat mainly vegetables, fruit and protein, and some grains like oats and quinoa, I feel great. I do exfoliate my skin and moisturize it, when I stop and get lazy some of my KP comes back. For some people it doesn’t go away fully but it can be managed. For me everything I do health wise improves my skin condition and I’m inspired by the results. Thank you this article.

Hi Susanab,

Thanks for sharing your experiences.

I have also had KP. I’m a breast cancer survivor and when I was on chemotherapy it went completely away. Mine came back after I completed chemo, but not nearly as severe.

I find it is much better when I go to the beach. I don’t know if it’s sunshine, sunscreen, salt water, or the combination. Have you experienced this?


Thanx for giving an answer. I’ve been asking myself what kind of rash I had. Thank you doctor.

I have what sounds like the same condition. I am about to turn 17 years old and it seems as if they are getting worse by age, not better. I also a little bit of redness on my checks. My arms, only on top of the arm, are fully covered and had mild redness. Some lotions and products have only made them worse. I have always wanted to pressure a music career but have been turned down because of “Keratosis Pilaris”. I am hoping to get a few helpful tips to help reduce the redness and bumps.

Danke und auf wiedersehen

My brother has this. He takes his oils and it helps. (Cod liver oil, vitamin E, eating coconut oil, applying coconut oil, etc.)

Who told your brother to take cod liver oil, vitamin e, eating and applying coconut?

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!!!

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

your just a loving caring mother as I am too. I also become iron deficient, coming and going (including other vitamins at times). I also get the small rash and dry skin, mostly on my upper arms, behind ears and back neck. I’m 41 now but i remember my father and older brother sitting in the back with just a vest on showing his musculer body and not embaressed about his rash. my son may become the same. hope you get help.

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.

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.