Chicken skin ( goose bumps) or Keratosis Pilaris by its dermatology moniker, is a genetic disorder caused by a defect in the way keratin is formed around the hair follicle. This is a very common ( 50-80% children and 40% adults) benign condition in which small, rough, keratotic papules (bumps) are formed adjacent to hair follicles.
Keratosis Pilaris, genetically, is felt to be autosomal dominant with variable penetrance. Oftentimes, when I take a family history, the patient will mention an uncle or cousin with it.
Keratosis Pilaris is most often found on the outer-upper arms, thighs and cheeks. KP is sometimes associated with atopic dermatitis (eczema), hay fever and asthma. More often it is aligned with icthyosis vulgaris (fish-scale disease)
KP is essentially a cosmetic problem. It is known to improve during the summer and usually remits as one gets older. Occasionally, when seen by the dermatologically unsophisticated, it is mis-diagnosed as acne. This especially occurs when the lesions occur on the cheeks, a fairly common location for this annoying disorder.
While there is no cure for this problem, which can be lifelong, there are a variety of treatments. Mild cases may only require moisturization, which should be used on all cases. Cerave, Cetaphil, or Epiceram are good. I find the old buff-puff often helpful. While out of favor for acne, I find this helpful for KP. After using the Buff-Puff alone for a few minutes add something containing salicylic acid. My favorite is Salix Lotion.
Other medications which can be used include things with Glycolic acid (Glytone, Bionic by Neo-Strata), Urea ( Carmol 20 or 40, Urix 40 or Umecta), or Lactic Acid ( Lac-Hydrin or Am-Lactin). Using a Retinoid such as Tazarac is also very helpful. However, unless you have KP in a lmited area (and have no intention to become pregrnant) this becomes very expensive.
A series of Beta-peels or microdermabrasion would be advised in intransigent cases. Beta peels using Salicylic acid are superior to Glycolic peel for reasons we discussed on our radio show on www.blogtalkradio.com October 15th.
The role of Vitamin A has been a complex one in the annals of Keratosis Pilaris. Phrynoderma, or Vitamin A deficiency, can give an appearance very similar to Keratotis Pilaris. Adding large amounts of Vitamin A to the diet, or treating a patient with Accutane, can essentially clear Keratosis Pilaris. However, now that we have good laboratory methods to detect serum Vitamin A, this does not seem to be the problem in KP. I did have a patient, a while back with intractable KP. She also had severe, cystic acne. When I placed her on Accutane, her Keratosis Pilaris vanished. However, unless severe cystic acne is concomitant, I would not recommend this route.
Some time ago, the late highly esteemed dermatologist Walter Shelley ascribed Keratosis Pilaris to a toxin released by strep in the throat ( an Alpha strep not the sometimes deadly Beta Strep). He advised the use of Erythromycin. I did try this remedy on some patients, was disappointed, and dropped it from my armamentarium.
However, on inflamed cases, a short course of Tetracycline may be quite beneficial.