Keratosis Pilaris – Understanding Those Little White Skin Bumps

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Keratosis pilaris - understanding those little white bumps on the skin

Healthylife Pharmacy11 August 2017|4 min read

Ever had those annoying white pimple-like bumps appearing on your upper arms, legs or other parts of the body and wondered what they are? 

Often referred to as ‘chicken skin’ or ‘goose flesh’, keratosis pilaris (KP), also known as follicular keratosis, is caused by an over-production of the protein keratin, which blocks hair follicles and causes bumps to appear on the skin's surface. Perifollicular erythema, redness surrounding the hair follicle, may often be seen.  

The inflammation and bumps commonly occur on the thighs, buttocks, upper arms and sometimes the cheeks of the face. It may begin in childhood and is most common in adolescence and may also affect adults. It doesn’t usually cause any pain and generally improves over time, so in Australia, keratosis pillaris treatment is considered unnecessary.  

Why does it happen?

The reason for occurrence is not understood but some theories suggest a defect in the keratinisation in the hair follicle or a lack of sebaceous gland at the base of the hair follicle.

Sebaceous glands are the sebum-producing glands that provide lubrication to soften the skin and support epithelial barrier protection, skin protection from water loss, water penetration and pathogenic bacterial invasion.

These glands are found attached at the base of the hair follicle and it is thought the absence of them in KP is the beginning of the development of the condition, resulting in epithelial barrier abnormalities. Perifollicular erythema, inflammation,  occurs possibly because of the breakdown of the skin barrier. The condition may get worse in dry or cold weather and there is an association with vitamin A and essential fatty acid deficiencies.

Who does it affect?

KP skin seems to appear around the age of two or in the teenage years. It may be an inherited condition and often occurs in people suffering from:

  • dry skin
  • ichthyosis vulgaris (a skin condition that causes very dry skin)
  • atopic dermatitis 
  • asthma 
  • hay fever 

The condition is usually diagnosed on appearance with no further testing required and may resolve independently without treatment.

Could gluten be to blame?

Gluten intolerance or sensitivities are often blamed for many diseases, but there is no substantial evidence to imply it is a culprit. What is thought could happen is that gluten may be causing gut inflammation or malabsorption of essential fatty acids and vitamin A.

If you have little bumps on your arms or other parts of your body and are concerned that you are sensitive to gluten, talk to your healthcare professional.

Lack of essential fatty acids

The polyunsaturated fats omega-3 (you may know this as fish oil or flaxseed oil) and omega-6 (think evening primrose oil, sunflower, safflower and borage oil) are essential (need to be provided in the diet) for healthy functioning of the skin. 

The omega 6s support the barrier functioning of the skin, provide protection from pathogens entering the skin and help maintain fluid balance. The omega 3’s, along with 6’s, support the signalling function and inflammatory response. 

Support the diet of essential fatty acids by eating plenty of fatty fish, flaxseeds, walnuts, almonds, avocado, olives and olive oil, eggs, dark green leafy vegetables and soy.

Vitamin A

Vitamin A is a fat-soluble vitamin tat is required for many processes in the body, including the development and maintenance of epithelial tissue, such as the skin. 

A deficiency of vitamin A has been shown to cause many glands, including sweat and sebaceous glands to shrink and to interfere with normal keratinisation..

Vitamin A may become deficient in people with digestive health issues such as malabsorption or chronic diarrhoea.

Vitamin A is found in the following foods:

  • apricots
  • carrots
  • sweet potato
  • egg yolk
  • butter
  • kale
  • spinach 
  • broccoli
  • cod liver oils

Because vitamin A is a fat-soluble vitamin it can accumulate in the body, so high doses for prolonged periods of time should be avoided.

Skin exfoliation

Skin cells take approximately a month to be created in the dermis and move their way to the skin’s surface where they are considered to be keratinised and naturally sloth off the skin. 

Skin exfoliation may help this natural exfoliation process by removing the hardened keratin plugs from the follicle. 

Creams containing salicylic acid, hydroxy acid and lactic acid may be applied to help loosen and remove the dead skin cells but these products may irritate, so using natural products may be a better alternative.

Moisturise

Moisturising with creams containing vitamin A (retinoids) may help by causing the cells to accelerate turnover time and unplug the blocked follicles. The downside to vitamin A creams is they can be harsh on the skin, make the skin sun sensitive and are not recommended in breastfeeding and pregnancy.

Other oils, particularly rosehip oil, contain naturally occurring vitamin A and may be a safer, gentler alternative. Moisturising can soften the skin allowing for the plugs of hardened sebum to exfoliate..

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References

  1. http://www.mayoclinic.org/diseases-conditions/keratosis-pilaris/diagnosis-treatment/treatment/txc-20168391
  2. Gruber, R., Sugarman, J., Crumrine, D., Hupe, M., Mauro, T. M., Mauldin, E. A., Thyssen, J. P., Brandner, J. M., Hennies, H. C., Schmuth, M., & Elias, P. M. (2015). Sebaceous Gland, Hair Shaft, and Epidermal Barrier Abnormalities in Keratosis Pilaris with and without Filaggrin Deficiency. The American Journal of Pathology, 185(4), 1012–1021. https://doi.org/10.1016/j.ajpath.2014.12.012 
  3. Thomas, M. A., & Khopkar, U. (2012). Keratosis pilaris revisited: Is it more than just a follicular keratosis? International Journal of Trichology, 4(4), 255. https://doi.org/10.4103/0974-7753.111215 
  4. Essential fatty acids and skin health. (2024, January 2). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/health-disease/skin-health/essential-fatty-acids#overview
  5. Vitamin A and skin health. (2024, January 2). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/health-disease/skin-health/vitamin-A#deficiency 
  6. Pennycook, K. B. (2023, June 26). Keratosis pilaris. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK546708/ 
  7. Djuricic, I., & Calder, P. C. (2021). Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated Fatty Acids on Human Health: An Update for 2021. Nutrients, 13(7), 2421. https://doi.org/10.3390/nu13072421
  8. Kaur, N., Chugh, V., & Gupta, A. K. (2014). Essential fatty acids as functional components of foods: a review. Journal of Food Science and Technology, 51(10), 2289–2303. https://doi.org/10.1007/s13197-012-0677-0
  9. Carazo, A., Macáková, K., Matoušová, K., Kujovská Krčmová, L., Protti, M., & Mladěnka, P. (2021). Vitamin A Update: Forms, Sources, Kinetics, Detection, Function, Deficiency, Therapeutic Use and Toxicity. Nutrients, 13(5), 1703. https://doi.org/10.3390/nu13051703
  10. Grajqevci-Kotori, M., & Kocinaj, A. (2015). Exfoliative Skin-peeling, Benefits from This Procedure and Our Experience. Medical Archives, 69(6), 414–416. https://doi.org/10.5455/medarh.2015.69.414-416
  11. Ganceviciene, R., Liakou, A. I., Theodoridis, A., Makrantonaki, E., & Zouboulis, C. C. (2012). Skin anti-aging strategies. Dermatoendocrinology, 4(3), 308–319. https://doi.org/10.4161/derm.22804
  12. Pham, C. T., Hosking, A.-M., Cox, S., & Atanaskova Mesinkovska, N. (2020). Therapeutic response of facial papules and inflammation in frontal fibrosing alopecia to low-dose oral isotretinoin. JAAD Case Reports, 6(5), 453–456. https://doi.org/10.1016/j.jdcr.2020.01.030