4 Effective Treatments for Keratosis Pilaris

Keratosis pilaris—those pimply, sandpapery areas on the backs of your arms (among other places)—can be smoothed over with a surprising hybrid skin-care strategy.

Photo by Elinor Carucci

As a general life rule, it’s best not to make mountains out of molehills. The exception: keratosis pilaris (KP), a condition that causes patches of fine bumps on the backs of your arms (and sometimes thighs and rear). KP isn’t dangerous, contagious, or painful, but that doesn’t make it any less of a Big Beauty Bummer—especially if you’re in a tank top.

The root cause is genetics. Up to 50 percent of the population, mostly women, are inherently programmed to overproduce keratin, a protein that’s a building block of skin, according to Joshua Zeichner, M.D., the director of cosmetic and clinical research in the department of dermatology at Mount Sinai Hospital, in New York City. That excess keratin ends up getting trapped inside hair follicles and forming hard plugs that become raised and rough to the touch. These inflame the surrounding skin, which then turns red.

Why KP surfaces as patches on particular body parts is a mystery. What doctors do know is that KP often exists in conjunction with certain unrelated skin conditions, such as eczema. Dryness tends to exacerbate KP, which is why you’ll notice it more in the summer, when sun and salt water dehydrate skin, and in the winter, when humidity is low. The condition can also flare up when hormones fluctuate—for example, during pregnancy or your period. Other experts point to obesity as an aggravating factor. Left untreated, KP sometimes improves on its own as you age.

What can you do in the meantime? Unfortunately, no medication zaps away the condition for good. But mix and match a bunch of strategies typically designed to target a slew of other skin problems and suddenly you have a seriously effective way to temper or even tamp out those patches, at least for a while. Here's what to do.

Adopt a Sensitive-Skin Cleansing Routine

KP-ridden skin may feel tough, but you have to treat it like a baby’s when bathing or showering. Hot water can strip away oils, allowing the skin’s moisture to escape, which then leads to dryness. The dead, dry skin cells build up excessively around the follicles, which is further compounded by hair that becomes trapped under the excess keratin. As a result, the patches look even more obvious.

Keep bathwater lukewarm, and limit exposure to 10 minutes or less, says Mary Lupo, a dermatologist in New Orleans. Also remember that soaps and cleansers with harsh lathering agents, like sodium lauryl sulfate, and heavy fragrances can be drying. Stick to gentle cleansers that contain soothing ingredients, such as glycerin, aloe vera, and cucumber extract. Try Dove Sensitive Skin Unscented Beauty Bar ($13 for four, amazon.com), Fresh Soy Cleanser ($15, sephora.com), and Lush Honey I Washed the Kids Soap ($8, lushusa.com). Finally, drop the loofah and other mechanical exfoliators. “Their abrasiveness can leave skin more parched and inflamed,” says Meghan O’Brien, a New York City dermatologist.

Steal a Trick From the Acne-Prone

Acne body washes are not just for acne; they’re also great for KP. Why? The active ingredients—most commonly alpha hydroxy acids (including glycolic acid) and beta hydroxy acids (including salicylic acid)—“help to exfoliate the abnormally accumulated keratin,” says Lupo. Try Neutrogena Body Clear Wash ($7 at drugstores and amazon.com), which contains salicylic acid. Squeeze a dollop of the spot treatment onto a damp, soft washcloth and rub the area gently in the shower.

Moisturize As If You Have Dry Skin

A super-rich body cream with lanolin, glycerin, or petroleum jelly, like Curel Ultra Healing Lotion ($10 at drugstores and amazon.com), can help calm KP. Apply it on rough spots right after bathing, when skin is still damp. “This seals in moisture so it penetrates deeper and lasts longer,” says Zeichner.

Call in the Retinol

If you don’t see improvement using hydroxy acids after four to six weeks, add retinol to your routine. Retinol, a form of vitamin A, has been clinically proven both to enhance the unclogging of pores and to stimulate collagen production. “Retinol-based products smooth the skin by gently exfoliating to remove dead skin cells and imperfections,” says Jessica Weiser, M.D., of the New York Dermatology Group, in New York City. Start with an over-the-counter product, like Chantecaille Retinol Body Treatment ($96, nordstrom.com), and proceed slowly. “After cleansing, apply a pea-size dollop to dry skin only every other day, to give your skin a chance to acclimate. Once the area shows signs of improvement in texture and tone, use it nightly,” says David Colbert, a New York City dermatologist and the founder of Colbert M.D. Skincare.

You should see results in three to six months. If not, consult a dermatologist, who may prescribe a more potent, prescription-strength retinoid, like Tretinoin or Renova, or a softening and healing agent, like urea, which helps dissolve and soften plugs more intensely. As a last resort, you can opt for either an in-office light chemical peel (cost: about $300), which gets rid of excess keratin with low doses of acid, or microderm-abrasion ($150), which gently sands down and smooths the skin via a handheld device.

Consider Laser Hair Removal

Yes, really. An intense pulsed light (IPL) laser, typically used to remove hair at the follicles, may improve KP, too. While eviscerating each strand, the laser takes away the pore-blocking keratin along with it. Recurrences of the hair and excess keratin are probable, but chances are you’ll have smoother, less red skin for six months. (Cost: $500 per session; you may need several.)