Your Kid Probably Has Hyperkeratosis Pilaris. Is That a Problem?

I see this every day. Some parents and kids are really freaked out by it. Most of the population has it. It may have an inherited component, and run in families. Many are unaware they are walking around with it. By and large, this is a painless phenomena, but causes a fair amount of consternation. It has a horrible, bad diagnosis-sounding name, and it is no big deal. I am talking about hyperkeratosis pilaris, of course.

What is this exactly? Take a second to look at the outer and posterior aspect of your upper arm, and tops of the thighs, and you will get a better idea. In around 40% of the population, and up to 80% of all adolescents, you will find zones of regularly spaced, red or skin colored bumps on these surfaces. Those with hyperkeratosis pilaris (HP) rashes will note they are painless, and may mildly itch from time to time. Hot weather or tight clothing or sports gear may predispose these teeny lesions to some irritation, but it usually subsides without fanfare. However, there is something about this ubiquitous eruption that drives mothers crazy.

I get this a lot, with a mom spinning her 12 year old around and hiking up a sleeve: “What is this? My daughter has goosebumps all the time, just here! Can you treat this?” Well put. Let’s delve.

Normally, adults and children shed their outermost skin cells—our keratinocytes–all the time. Eventually, this becomes dust on our floor, or fodder for the dust mites in our bed. Yum. Keratin is a fibrous protein found in hoofs, claws, feathers, and in this case, in our skin’s keratinocytes.

In hyperkeratosis pilaris (HP), keratin plugs the hair follicles most pronouncedly in certain areas of the body; especially the arms and thighs, as noted, and less often the neck, cheeks and buttocks.  A quick check shows patches of bumps with a distribution mapped to hair follicles (regularly spaced apart, not clustered together). For those most curious, lesions may sometimes have hair growing out of them, or have a trapped coil of a growing hair inside.

Debate has raged (in sleepy, derm-y circles) over the years as to whether there is an association between HP and eczema. Seems not. However, HP may intensify with with periods of increased hormone production, as during puberty. HP also seems to occur more in females than males. Sorry, girls. And, kids and adults with hyperkeratosis pilaris note it tends to be more pronounced in dryer, colder weather.

As medical conditions go, hyperkeratosis pilaris rates as a classic ‘annoying but not dangerous’ category—joining such celebrated maladies as long nose hair, newborn acne, and chapped lips. But, for those truly bothered, either by cosmetic concerns or a bit of itching, there are ways to reduce or dampen the rash’s symptoms and appearance.

Taking a page from the eczema playbook, kids and teens with HP should avoid steaming hot showers, and use warm to tepid water, and dab dry afterwards. This averts cycles of inflammation that can make it worsen. Mild, unfragranced soap should be used while bathing (Dove rocks), and a greasy, emollient ointment (e.g. petroleum jelly) can be applied to the affected area once or twice a day.

For kids who have more extensive cases, including redness, irritation, or a concern that the rash has become tender or infected, a check-in with a health provider is a good idea. Inflamed or widespread rashes may require a topical steroid ointment, and/or a pricey salve (a lactic acid, or retinoid cream) to break down the keratin plugs on the troubled patches of skin and allow things to heal up.

Hyperkeratosis pilaris will eventually go away by the late teens in about a third of cases. For the majority of children, teens and adults (and, I’d venture, for people reading this piece), HP is something one can live with and not worry about, if understood and treated right. Getting treatment for flares of inflammation or questions of infection is important. And, consider the bright side.

This newfound medical knowledge can enhance a tried and true backseat game for siblings on long car rides. Instead of older siblings one-sidedly bamboozling younger brothers by teasing: “Your epidermis is showing…”, the battle equation can be rebalanced. Now, you can prepare the little sibling to retort: “Maybe so, but your hyperkeratosis pilaris is erythematous and papular!”

That’s so cool, it’ll give you permanent goosebumps!

nice photos by kp

cartoon below by me

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