Keratosis pilaris, or rubbing iron skin, is a common keratinization disorder that results in keratinized, rough-feeling papules on the skin. The disorder is very common and affects mostly adolescent girls. The complaint is usually purely cosmetic and can generally be treated well with hygiene measures and ointments, but not cured.
What is keratosis pilaris?
Keratosis pilaris (also known as lichen pilaris, keratosis follicularis, horny nodular lichen or colloquially as friction iron skin) is a presumably genetically caused keratinization disorder that affects the skin or hair follicles, respectively, primarily in the area of the upper arms, thighs and face. Follicular hyperkeratosis develops. This means that the structure-giving protein keratin is produced in excess, causing hardened nodules to form on the surface of the skin.
Causes
Keratosis pilaris forms when the protein keratin, which is also found in hair and nails and is responsible for their stability, is produced in excess in the hair follicles (follicular hyperkeratosis). As a result, the epidermis thickens and the follicular opening becomes blocked, leading to the typical rubbing iron structure of the skin. The basic cause of the keratinization disorder is unclear, but a genetic predisposition is considered certain, since keratosis pilaris accumulates in families. If one person is affected, the probability of further affected family members is 50 to 70 percent. Presumably, the corresponding gene is inherited in an autosomal dominant manner.
Symptoms, complaints, and signs
Patients with keratosis pilaris have a typical rub-like rough skin surface. Approximately pinhead-sized, cone-shaped papules form, whose appearance is reminiscent of the so-called goose bumps. Since keratin is deposited in the hair follicles, the elevations are hard and rough. Sometimes it happens that the keratin pads close the hair follicle to the outside, so that regrowing hairs cannot grow through the skin to the outside, but curl up in the follicle. Such ingrown hairs can become painfully inflamed in rare cases. The main areas affected by friction skin are the upper arms and thighs. Sometimes the face, neck, scalp and buttocks can also be affected. The complaints are normally of a purely cosmetic nature, but can be quite distressing for those affected, especially during puberty. Only very rarely does itching or pain occur.
Diagnosis and course of the disease
Keratosis pilaris is a visual diagnosis that can be made by the family doctor or dermatologist. Dermoscopy may be used for more detailed examination. Since cases of rubbing iron skin often cluster in families, taking a family history is helpful in making the diagnosis. Several different subtypes can be distinguished diagnostically, including keratosis pilaris rubra, which results in red, inflamed elevations on the arms, legs, and head; keratosis pilaris alba, in which the keratinizations are not inflamed; and keratosis pilaris rubra faceii, which appears on the face. Keratosis pilaris does not lead to any health limitations. However, when symptoms appear in atypical areas, other skin diseases should be excluded by differential diagnosis. In addition, the skin often appears in connection with diseases such as neurodermatitis, bronchial asthma, allergies or ichthyosis vulgaris, so that further diagnostics for these diseases can be carried out if necessary in the case of corresponding symptoms. The disease may remain relatively unchanged for years, but tends to decrease or disappear completely with increasing age. Puberty, pregnancy and lactation, on the other hand, often lead to more severe episodes. Scratching the keratinized areas can lead to local inflammation, which causes local symptoms to worsen.
Complications
Usually, keratosis pilaris does not result in a health-threatening condition for the patient. This disease is predominantly a cosmetic problem. As a result, girls in particular not infrequently suffer from psychological complaints or depression. Furthermore, children may also be bullied or teased, which often leads to the development of inferiority complexes or reduced self-esteem.Especially during puberty, keratosis pilaris can be very distressing for children and significantly reduce their quality of life. Likewise, in some cases, patients suffer from pain or even itching. Furthermore, keratosis pilaris also occurs in the presence of allergies or respiratory diseases. Therefore, if the affected person also suffers from these complaints, it is advisable to consult a specialist. Treatment of this disease is usually carried out with the help of medications and care products. With these, most of the complaints can be limited. Often, increased personal hygiene also helps to fight this disease. Further complications do not occur. The life expectancy of the affected person is also not limited by keratosis pilaris.
When should one go to the doctor?
Keratosis pilaris of the skin is considered unusual, especially in children, and should be evaluated by a physician. Although keratosis pilaris is not curable, medical treatment can be initiated that will lead to an improvement in symptoms. A visit to the doctor is necessary so that the cause of the changes in the skin appearance can be investigated in tests and a diagnosis can be made. If the existing skin abnormalities and peculiarities spread or if there is a deterioration of the skin appearance in the affected areas, it is advisable to consult a doctor. If papules develop, swelling occurs or physical hair growth fails to appear on the affected regions, a doctor should be consulted. If inflammation occurs, pus forms or the regrowing hairs turn into the skin, a visit to the doctor is recommended. In case of itching and the development of open wounds, sterile wound care should be ensured. If this cannot be ensured or if existing wounds increase in size, a doctor should be consulted. In severe cases, there is a risk of blood poisoning, as germs can enter the organism via the body sites. If the affected person suffers emotionally from the skin changes, a doctor should also be consulted. Therapeutic support is needed in the case of behavioral abnormalities, changes in personality or severe mood swings.
Treatment and therapy
Keratosis pilaris cannot be cured by therapeutic measures. However, its symptoms can be alleviated until the keratosis disorder gives itself, if necessary, as the affected person ages. The most relevant measures include the area of personal hygiene and can be performed by the patient himself. Regular cleaning of the affected areas is important. For this purpose, lotions containing soap should be avoided completely or at least pH-neutral soap should be used. Patients should also not take excessively long showers so as not to dry out the skin. Subsequently, the affected areas should be cared for with lipid-replenishing and moisturizing lotions. Care products containing urea are particularly beneficial, as this binds moisture and loosens the horny areas. Other medical ointments contain salicylic acid, hydroxycarboxylic acids or lactic acid. These creams can also be applied overnight as a care mask if necessary. If these everyday hygiene measures are not enough, peels with salicylic, lactic or fruit acids can help remove the horn plugs. However, both medicated ointments and acid peels should only be used in consultation with the treating physician. In more severe cases, ointments containing glucocorticoids (cortisone) may also be used. Laser therapy is also possible, but like the ointments mentioned, it only promises relief, not a cure. Basically, keratosis pilaris patients should make sure to drink enough fluids and get moderate sun exposure to stimulate vitamin D production.
Outlook and prognosis
In the presence of keratosis pilaris, also called friction iron skin, the affected person can usually take charge of his or her own treatment. Moisturizers containing urea keep the skin supple and promote more rapid desquamation, thereby alleviating keratinization. With the help of peelings, dead skin cells are removed and the appearance and feel of the skin is improved. Chemical peelings based on ingredients such as salicylic acid, fruit acid or lactic acid help here. Mechanical exfoliation, for example with callus rasps or pumice stones, is not advisable as these can easily injure the damaged skin and possibly cause inflammation.In the case of particularly sensitive skin, the patient can also resort to creams with vitamin A. These achieve a similar effect to chemical peels, additionally stimulate the formation of new cells and are gentler on the skin. Some sufferers notice an improvement in the skin’s appearance in summer when exposed to increased sunlight. You can discuss with a dermatologist the possibility of light therapy, which, unlike in a normal solarium, is directly adapted to individual needs. In some cases, a change in diet leads to a significant improvement in symptoms. It varies from individual to individual whether abstaining from addictive substances, sugar, coffee or even gluten brings about an improvement or rather the change to a vitamin-rich diet with sufficient fluid intake.
Prevention
Keratosis pilaris cannot be completely prevented if the patient is predisposed to it. However, symptoms can be significantly alleviated or even prevented in advance by adequate care and precautions. These measures are particularly important in winter, as the so-called rubbing iron skin shows itself particularly strongly during this time. Here then many of the already mentioned treatment measures (cleaning, creaming if necessary with medicinal ointments, peelings) take effect.
Aftercare
The affected person usually has only very few aftercare measures available for keratosis pilaris. At the same time, these are severely limited, so that first and foremost a rapid and, above all, an early diagnosis should be made by a physician. A doctor should be contacted at the first signs or complaints of the disease to prevent further complications or complaints. Self-healing cannot occur with keratosis pilaris. Treatment is usually carried out by the application of various creams or ointments. The affected person should always pay attention to the correct dosage and also to the regular application in order to alleviate the discomfort properly and, above all, permanently. If there are any questions or if anything is unclear, the doctor should always be consulted first. The symptoms rarely disappear on their own, so a doctor should be contacted if the treatment does not lead to the desired result. Since keratosis pilaris can also reduce the aesthetics of the affected person, intensive and loving conversations with one’s own family or friends are very helpful. This can prevent psychological discomfort or even depression. As a rule, keratosis pilaris does not reduce the life expectancy of the affected person.
What you can do yourself
Keratosis pilaris usually does not require medical treatment. Affected persons can alleviate the rubbing skin by determining the causes of the keratinization and then taking very specific countermeasures. Above all, regular care of the affected areas of the body is important. Frequent peelings help to remove the dead skin cells and thus improve the skin’s appearance. Applications with salicylic acid are particularly effective, as the active ingredient has an anti-inflammatory effect and dissolves the blockages. Various oils, for example olive, coconut or argan oil, also provide a cleaner skin surface. In some cases, sun rays improve the skin condition. Sea water is also said to help and can be applied pure or in the form of ointments and lotions. In addition, a healthy diet is recommended, which should contain as little gluten as possible and as much fresh fruit and vegetables as possible. Too much sugar and stimulants such as alcohol, nicotine and coffee should be avoided. Those affected should also drink plenty of water. Regular visits to the sauna give the skin additional moisture. Sports and the avoidance of stress support these measures and improve the overall well-being. If keratosis pilaris does not diminish despite all this, it is best to consult the family doctor or a dermatologist.
