Keratosis pilaris, also called chicken skin, is a common skin condition that can lead to rough bumps on the skin. It commonly involves arms and legs; however, it can involve any area of the body with hair follicles including the face (especially the sides of the cheek) and the sides of the neck.
Keratosis pilaris cannot be cured but it may improve with age and the appearance can be improved with treatments.
While treating keratosis pilaris on the face and neck, one has to follow a gentler approach. Any irritation can worsen keratosis pilaris.
Symptoms
Keratosis pilaris can lead to rough bumps on the face especially on the sides of the cheeks and sides of the neck. It is often seen in children and teenagers. The symptoms may get worse with hormonal changes or in dry weather.
The common variant of keratosis pilaris is usually not inflamed and does not itch or hurt. The color of the bumps may vary with the skin tone. It may be red in lighter skin tones and skin-colored, purple, brown, or black in darker skin tones.
In addition, some people may have a variant of keratosis pilaris, and the symptoms of this may vary.
The variants include:
- Keratosis pilaris rubra faciei: This variant presents with rough bumps that are red in color. The skin surrounding the bumps is also red in color. It can appear like a red rash. It commonly involves the cheeks and neck.
- Erythromelanosis follicularis faciei et colli: This variant presents with rough bumps, redness, and hyperpigmentation. It commonly involves the cheeks and sides of the neck. It is usually seen in young adults.
- Keratosis pilaris atrophicans: This variant can lead to atrophy, scarring, and patches of hair loss. It commonly involves the skin of the cheeks and lateral eyebrows. It is usually seen in children.
How often does it involve the face and neck?
There is not a lot of data, but one study looked at the body site involvement in 49 patients with keratosis pilaris. The most commonly involved sites were the arms (92%), legs (59%), face (41%), buttocks (30%), and eyebrows (8%).
Causes
Keratosis pilaris is thought to occur due to the plugging of the hair follicles with keratin. Keratin is a protein and is part of our skin, hair, and nails.
This may occur due to abnormal keratinization resulting in too much keratin production by the cells lining the hair follicles.
Another explanation is that coiled hairs can damage the epithelial lining of hair follicles resulting in inflammation and keratin buildup.
Why it occurs in some people is not entirely clear. Genetic factors are thought to play a part in it.
In addition, some people are at increased risk of keratosis pilaris. These include individuals with a family history of keratosis pilaris, personal history of atopic dermatitis, allergies and dry skin conditions, obesity, and diabetes.
Look-alikes
The bumps of keratosis pilaris can often be mistaken for other skin conditions like milia, acne, rosacea, or folliculitis.
It is important to differentiate these as the treatment of each varies.
- Keratosis pilaris is usually not itchy or painful and in most cases, it is symmetrical meaning you will see the bumps on both sides of the affected area like both cheeks or arms.
- Folliculitis is often itchy and can present with red bumps or pus-filled bumps.
- Acne presents with different types of acne lesions like comedones, red bumps, pustules, or cysts.
- The bumps of milia usually have a smooth surface.
- Rosacea may be associated with itching and burning. In addition, one will often experience episodes of flushing. Broken capillaries may also be seen.
Can it go away on its own?
Keratosis pilaris may go away on its own with age. In addition, the rough texture may improve in summer.
There is no cure or treatment to completely get rid of keratosis pilaris. However, there are several treatments that can improve the appearance of rough bumps or chicken skin.
Treatment
The skin of the face and neck is different from the rest of the body. It’s a lot more sensitive and many products which are meant to treat keratosis pilaris on the body may be too harsh for facial skin.
So, if you are dealing with keratosis pilaris on your face or neck, it’s important to choose products that are specifically meant for the face.
Note: Many topical treatments for keratosis pilaris are not safe for pregnant women. Also, these treatments may not be suitable for the sensitive skin of young children.
1. Urea
Urea is a keratolytic and can get rid of layers of dead skin cells giving a smooth appearance to the skin. In addition, it’s a humectant and can hydrate the skin.
There are few facial creams with a lower concentration of urea (such as Eucerin Dry Skin Replenishing Face Cream Night 5% Urea and Rohto Mentholatum – Hada Labo Koi-Gokujyun Perfect Gel) that can be used safely and effectively to treat keratosis pilaris on the face and neck.
2. Hydroxy acids
Keratosis pilaris can be improved by exfoliants which can remove the dead skin cells from the surface. This can flatten the bumps and improve the rough texture. These include:
- Alpha-hydroxy acids like glycolic acid, and lactic acid.
- Beta-hydroxy acids like salicylic acid.
If you have sensitive skin, you can opt for polyhydroxy acids like gluconolactone and lactobionic acid. Their molecules are much bigger so they cannot penetrate very deeply into the skin and can be less irritating.
3. Retinoids
Retinoids are vitamin A derivatives that increase skin cell turnover. It can improve the bumpy texture of the skin.
You can get several retinoids like retinol, retinaldehyde, or adapalene (1%) over the counter.
If these do not help, you can visit your dermatologist or a doctor who can prescribe a prescription-strength retinoid like tretinoin or tazarotene which may be more effective in improving the appearance of keratosis pilaris.
4. Azelaic acid
Azelaic acid is not often mentioned for treating keratosis pilaris. However, if your skin is extra sensitive and you’re not able to tolerate any exfoliant or retinoid, you can try using products with azelaic acid.
It prevents hyperkeratinization and has anti-inflammatory properties. This can reduce the bumpy rough texture of the skin.
5. Lasers and other procedures
If your skin does not respond to over-the-counter topicals you can visit your doctor and explore more options like lasers.
Lasers use a wavelength of light to target hair follicles or blood vessels in the skin. This can improve the redness and the bumpy texture of the skin.
Your doctor may also recommend procedures like microdermabrasion and chemical peels which when used in conjunction with other treatments can improve the appearance of keratosis pilaris.
These procedures should only be done by a professional to avoid any scarring and hyperpigmentation, especially in darker skin tones.
Other measures to follow
1. Use lukewarm water
Use lukewarm water to wash your face and take a bath. Hot water can damage your skin barrier and can cause dryness and irritation.
2. Use a pH-balanced cleanser
Harsh cleansers and soaps can strip the skin of its natural barrier and make it prone to irritation and redness. It can also worsen the appearance of keratosis pilaris. So, use a pH-balanced cleanser to cleanse your skin.
3. Moisturize every day
Moisturizing your skin can normalize the skin’s natural exfoliation process. This can give a smooth appearance to the skin. Moisturizers can also help your skin tolerate strong treatment products meant for keratosis pilaris.
4. Exfoliate gently
Exfoliation in combination with moisturization, is the key when it comes to improving the appearance of keratosis pilaris. However, at the same time, one has to be careful to not use multiple products which exfoliate the skin at the same time.
Always check the ingredients on your moisturizer label and your serums to make sure you are not using multiple exfoliants and retinoids together.
Use them alternately in your routine, like every other day or in the morning or evening routine.
In addition, if you’re using a moisturizer based on an exfoliant make sure to treat it as a treatment moisturizer and use it only once or twice per day.
For moisturizing your skin in between, use a simple hydrating moisturizer.
5. Avoid scrubbing and picking
It is better to avoid harsh scrubs and washcloths to exfoliate the sensitive skin on the face and neck. Instead, use chemical exfoliants which are gentler options.
In addition, avoid picking on the rough bumps as it can lead to hyperpigmentation.
6. Wear a sunscreen every day
Sun rays can worsen any redness or pigmentation. So always, protect your skin by using a broad-spectrum sunscreen.
7. Avoid hair removal
Avoid the use of waxing or shaving to remove hair from the area affected by keratosis pilaris. It can lead to irritation and can worsen keratosis pilaris. Instead, opt for laser hair removal.
8. Use a tinted moisturizer or concealer
It may be hard to cover the bumpy texture of keratosis pilaris. However, a tinted moisturizer may even out the skin. If you have a lot of redness associated with keratosis pilaris, you can use a green color corrector.
When to see a doctor
Keratosis pilaris is harmless and usually does not need treatment. However, one should see a doctor if:
- The appearance of keratosis pilaris affects your self-confidence.
- The bumps are painful or extremely itchy.
- The bumps are accompanied by other systemic symptoms.
- You are not sure what is causing bumps on your face and neck.
Key points
Keratosis pilaris, also called chicken skin, can lead to rough bumps on the skin. It commonly affects the arms and legs. However, keratosis pilaris can also involve the face and neck area.
The skin on the face and neck area is much more sensitive and one should use topical treatments which are meant specifically for the face.
Keratosis pilaris on the face and neck can be improved by the use of moisturizers, exfoliants, and procedures like lasers.
References
- Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. 1994 Jun;130(6):711-3. doi: 10.1111/j.1365-2133.1994.tb03406.x. PMID: 8011494.
- Maghfour J, Ly S, Haidari W, Taylor SL, Feldman SR. Treatment of keratosis pilaris and its variants: a systematic review. J Dermatolog Treat. 2022 May;33(3):1231-1242. doi: 10.1080/09546634.2020.1818678. Epub 2020 Sep 14. PMID: 32886029.
- Thomas M, Khopkar US. Keratosis pilaris revisited: is it more than just a follicular keratosis? Int J Trichology. 2012 Oct;4(4):255-8. doi: 10.4103/0974-7753.111215. PMID: 23766609; PMCID: PMC3681106.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.