Integrative Dermatology Approaches to Keratosis Pilaris: Specialty Testing, Supplements, and Treatment

Keratosis pilaris is a commonly seen skin condition where tiny bumps and dry, rough patches develop. It occurs most commonly on the arms, legs, and buttocks due to the build-up of excess keratin, a protein that helps form your skin's outer layer (epidermis). Sometimes, keratosis pilaris is referred to as "chicken skin" due to the appearance of the tiny red bumps on the skin that may resemble the look of the skin of a plucked chicken or goosebumps.

The bumps do not usually hurt or itch too intensely, although dealing with the condition can be embarrassing. In general, this condition does not cause further complications.

Keratosis pilaris is common, with an estimated 50 to 70 percent of all adolescents and 40 percent of adults experiencing the condition. This skin condition is more common in babies, toddlers, children, and adolescents, and it often worsens around puberty, resolving on its own by around age 30.

Fortunately, an integrative dermatology approach to keratosis pilaris can help minimize these little bumps' appearance and leave your skin looking clearer.

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What is Keratosis Pilaris?

Keratosis pilaris is a skin condition where tiny bumps and dry, rough patches occur. The bumps may look red, brown, or white or appear the same color as your skin. These bumps or folliculocentric keratotic papules are very small, up to around 1-2 mm.

Keratosis pilaris occurs when keratin and dead skin cells build up within the hair follicles. Keratin is one of the most significant proteins that make up the epidermis (the outermost layer of your skin) and hair. This causes the hair follicles to bulge and get irritated, giving them a rough and bumpy texture. Keratosis pilaris is sometimes called "chicken skin" due to the appearance of tiny bumps on the skin that may resemble the skin of a plucked chicken or goosebumps.

Keratosis pilaris can occur anywhere on the body that has hair follicles. It is most commonly experienced on the back of the arms, the front of the thighs, and the buttocks. However, this condition can also be found on the face, especially the cheeks.

Keratosis Pilaris Symptoms

Usually, keratosis pilaris presents with painless tiny bumps on the upper arms, thighs, cheeks, or buttocks. These bumps can be found on the skin anywhere that hair follicles exist, so they can occur everywhere except on your palms and soles. The most characteristic area for keratosis pilaris to occur is on the upper-outer arms.

They can be white, brown, red, or skin toned and may have surrounding redness due to inflammation. Sometimes, a small, coiled hair can be seen beneath the bump or papule. It may also involve some dry, rough skin in the areas with bumps that can cause mild itching. This rash can appear like sandpaper, chicken skin, or goosebumps. Other times, the bumps may be mistaken for small pimples since a keratin plug may be able to be expressed from each bump.

Ulerythema ophryogenes (keratosis pilaris atrophicans faciei) is an uncommon keratosis pilaris variant involving small horny, red bumps on the hair follicles of the eyebrows and cheeks. This form of keratosis pilaris may result in gradual hair loss in the affected facial areas.

The rash of keratosis pilaris may get more intense during seasonal changes, during winter or in locations with low humidity, or in other conditions that worsen dry skin. Dry skin can also make the bumps more noticeable.

What Causes Keratosis Pilaris?

Keratosis pilaris occurs when dead skin cells containing keratin build up in hair follicles. Keratin is a hard protein found in the epidermis or outer layer of the skin that protects your skin from harmful substances and infections and is needed for skin regeneration. Usually, dead skin cells containing keratin flake off the skin and are exfoliated. In keratosis pilaris, the keratin blocks the opening of the hair follicles, leading to rough and bumpy skin patches. The abnormal keratinization of the upper portion lining of the hair follicle fills up the follicle instead of being shed and exfoliated.

Some studies suggest that inside the clogged hair follicles, there may also be thick coiled hairs that rupture follicle cells, leading to inflammation and abnormal keratin release.

Several factors can contribute to the build-up of keratin that causes keratosis pilaris. This condition tends to be inherited, running in families. So, you are more likely to have keratosis pilaris if someone in your family also has it. In fact, 50-70% of people with keratosis pilaris have a genetic predisposition. Research suggests a correlation with genetic mutations in filaggrin, a key protein in skin barrier function.

Keratosis pilaris is also more common in people with various other skin diseases such as dry skin, atopic dermatitis or eczema, and ichthyosis, a condition where areas of skin are very dry and can have an appearance like fish scales. Those with asthma and hay fever are also more likely to experience this condition. In addition, people with hypothyroidism, Cushing's syndrome, diabetes, Down syndrome, and obesity have higher rates of keratosis pilaris.

Another factor that can exacerbate keratosis pilaris is dry air/low humidity. Keratosis pilaris tends to be prominent in the winter months due to the reduced moisture content of the air and in climates where humidity levels are low.

Dry skin, keratotic follicular papules, and a higher risk for keratosis pilaris are also characteristic of vitamin A deficiency. Other nutritional deficiencies associated with the skin changes characteristic of keratosis pilaris include vitamin C deficiency and essential fatty acid deficiency. Vitamin C is vital in maintaining skin health and the differentiation of keratinocytes, while omega-6 and omega-3 polyunsaturated fatty acids (PUFAs) play a critical role in normal skin appearance and function.

Age is another significant risk factor for keratosis pilaris. This skin condition is most frequent in children and adolescents, reaching its peak prevalence in adolescence around puberty and often resolving by adulthood. Since estrogen increases keratin growth, flares may occur with hormonal changes during puberty or pregnancy.

Functional Medicine Labs to Test for That Can Help Individualize Treatment of Keratosis Pilaris

Functional medicine testing can help uncover imbalances that may contribute to developing skin inflammation and keratosis pilaris. Laboratory testing can also monitor treatment and help bring the body back into balance.

Nutrient Balance

Since nutritional imbalances in vitamin A, vitamin C, and essential fatty acids can all play a role in skin conditions like keratosis pilaris, micronutrient testing can be used to examine the levels of minerals, vitamins, and other nutrients as well as the performance and functional deficiencies of these micronutrients.

The Essential and Metabolic Fatty Acids Analysis assesses the levels of both essential and non-essential red blood cell membrane fatty acids necessary in metabolism and cellular function to assess current levels and the need for potential supplementation or dietary modifications.

Comprehensive Stool Test

While specific research is still needed, gut health is closely tied to chronic low-grade inflammation that can exacerbate skin conditions like eczema that are related to keratosis pilaris. A comprehensive stool test like the GI-MAP can provide insights into the balance of gut bacteria, inflammatory markers, and zonulin (a key biomarker in detecting leaky gut that can contribute to inflammation).

Food Allergies & Sensitivities

Food sensitivities can contribute to increased leaky gut (intestinal permeability), inflammation, and skin barrier dysfunction in conditions like eczema, which can increase the risk of keratosis pilaris. Foods to which a person is sensitive can be identified with ELISA testing. Additional testing for gluten sensitivity with Genova Diagnostics Celiac and Gluten Sensitivity and evaluation of the leaky gut marker zonulin can also help assess sources of inflammation and gut imbalances to guide treatment.

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Conventional Treatment for Keratosis Pilaris

Conventional treatment for keratosis pilaris often uses moisturizing lotions that contain lactic acid, salicylic acid, glycolic acid, or urea. These agents hydrate the skin and also help to exfoliate excess keratin/dead skin cells. When topical treatments are unsuccessful, laser or light treatments may be used.

Complementary and Integrative Treatment for Keratosis Pilaris

While no known cure exists for this condition, you can manage keratosis pilaris with an integrative approach. These treatments involve an anti-inflammatory diet, replenishing essential nutrients, daily moisturizing, and gentle exfoliating.

Nutrition for Keratosis Pilaris

Since keratosis pilaris and related conditions like eczema, asthma, and allergies can be exacerbated by chronic low-grade inflammation, an antioxidant-rich, anti-inflammatory, whole-food diet like the Mediterranean diet can help to reduce overall inflammation in the body and allow the skin to heal.

Rebalancing gut bacteria and healing the gut barrier can significantly impact skin health. An imbalance, damaged, or leaky gut can contribute to chronic inflammation by allowing substances into the body that shouldn't be there, which triggers an immune response. Eliminating any foods you are sensitive or allergic to also helps heal the gut and balance inflammation. While studies are not yet completed, dietary manipulations such as gluten-free, dairy-free, or various autoimmune diet protocols may be implemented based on individual needs and functional medicine laboratory testing. Incorporating naturally probiotic-rich foods like sauerkraut and kimchi and food sources of prebiotics like green bananas, whole grains, and garlic can support a healthy microbiome.

Vitamin A is important for increasing skin cell turnover. Liver, fish, eggs, dairy products, leafy green vegetables, orange and yellow vegetables, tomato products, and fruits are good sources of this fat-soluble vitamin.

Omega-6 and omega-3 essential fatty acids regulate potent signaling molecules called eicosanoids, which influence the inflammatory response in the skin. Increasing essential fatty acid intake (specifically omega-3s) by consuming more coldwater fish such as salmon, sardines, mackerel, walnuts, and flax seeds can benefit skin health.

Supplements and Herbs for Keratosis Pilaris

If functional medicine testing reveals nutrient deficiencies, replenishment with supplementation may be helpful. Omega-3 fatty acids like fish oil or algae oil supplements can replenish essential fatty acids and provide a strong anti-inflammatory effect. Dietary supplementation with fish oil has been shown to influence the fatty acid composition of the epidermis and reduce inflammation in the skin.

When keratosis pilaris is associated with vitamin C deficiency, several months of supplementation may improve the skin.

Keep Skin Moisturized

Keeping the skin moisturized and hydrated is a crucial part of treatment for keratosis pilaris. Avoid drying out the skin by taking short, lukewarm showers instead of hot baths. Use a humidifier to maintain balanced humidity levels in drier climates or seasons.

Daily use of topical moisturizers such as coconut oil, olive oil, or vitamin A capsules can keep skin hydrated. These natural oils also provide added anti-inflammatory and antibacterial properties to help reduce discoloration and inflammation. Apply moisturizing agents to damp skin within five minutes of bathing and whenever the skin feels dry.

It is also important to stay hydrated from the inside out. Drinking enough pure water can help maintain hydrated skin and minimize the appearance of keratosis pilaris.

Gently Exfoliate

Gently exfoliating the skin prevents excess keratin build-up. Use small, circular motions with a loofah, washcloth, or exfoliating scrub to gently wash the affected skin areas while you shower or bathe. Natural exfoliants like baking soda, sugar, oatmeal, or salt scrubs can be helpful in reducing keratin build-up. A natural-bristle dry brush can also help to unclog pores and remove dead skin cells. Be sure not to scrub too hard to avoid additional irritation.

Apple cider vinegar (ACV) contains malic acid, a natural form of alpha hydroxy acid to exfoliate your skin. Apply a small amount of ACV diluted in an equal amount of water to a cotton applicator and rub it on the affected areas.

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Summary

Keratosis pilaris is a skin condition affecting nearly 50-80% of adolescents and 40 percent of adults. It occurs when a protein in the skin, keratin, builds up and blocks hair follicles, forming rough-feeling bumps on the skin's surface. Keratosis pilaris is sometimes called "chicken skin" because of the rough texture and tiny bumps that form in areas of the skin like the arms, thighs, buttocks, and cheeks.

Symptoms of keratosis pilaris are most common in childhood and adolescence and often resolve with age. While many factors are likely involved, keratosis pilaris is genetic and is associated with allergic conditions like eczema and asthma. Dry climates with low humidity, chronic inflammation, and deficiencies of vitamins A and C and essential fatty acids exacerbate it.

The most effective way to treat keratosis pilaris is to remove dead skin cells by gently exfoliating, moisturizing the skin daily, and nourishing the gut and body with a balanced anti-inflammatory diet. Supplementation with vitamin A, vitamin C, and essential fatty acids like those sourced from fish oil can also reduce excess inflammation in the skin.