Keratosis Pilaris (KP) is a skin condition comprised of a complex series of cascading symptoms caused by skin barrier issues around the hair follicle. At a cellular level, the skin cells around the hair follicle fail to join together in some areas, which causes microscopic gaps in the skin barrier to form.

These gaps in the skin barrier allow moisture from within your skin to pass outwards, which dries out the hair follicle. The defective skin barrier also allows bacteria and germs to pass into your skin. This triggers an immune response, which leads to redness and inflammation.

In parallel to these symptoms, you can also experience sebaceous gland atrophy, which reduces the amount of skin oil being produced at the hair follicle. This further dries out your skin and can lead to the hair follicle defects. Keratin scale can then begin forming in the hair follicle, creating the infamous bumps associated with KP.

These symptoms all result in what we recognize as Keratosis Pilaris. Red, pigmented, inflamed hair follicles that are impacted with keratin buildup.

Continue reading below to dive deeper into these symptoms! Also check out the blog post which contains an in-depth look at KP, complete with all cited sources and clinical studies.

Texture and visible bumps are typically the first symptoms of KP you notice on yourself or on your children. Many have found it hard to find effective treatment for their KP, even after seeking a formal diagnosis.

Why are these bumps appearing and what is causing them to form? From a 2015 study that can be found here, the build up of dead skin in the upper layers of our hair follicles, which are the bumps and texture associated with KP, seem to be triggered by dysfunctional skin cells that disrupt certain layers of our skin around the hair follicle and a lack of sebum (skin oil). Every person with KP has this disrupted follicular skin barrier, but the more prominent bumps appear to form when sebum decreases. After taking biopsies from the the skin of people with KP, it was discovered that the glands that produce skin oil (sebaceous glands) were in the process of shriveling up and disintegrating. We don't know for certain what causes this, but there are compelling theories that may help us to improve how we approach KP skin care. One theory that appears in this study, is that a deficiency of something called Insulin Growth Factor-1 (IGF-1) could be the cause of decreased sebum production and the observed disrupted skin barrier, leading to the bumps forming on our skin. There is also evidence that decreased IGF-1 may affect the process of stimulating new sebum production. In addition to regulating sebum, inhibiting IGF-1 receptors have also led to disrupted skin barriers in the following study.

Luckily, there is a more productive solution to this issue other than continuously trying to scrub layers of skin away or using topical acids. In our Soothe & Restore Lotion we have included Indigo Naturalis extract to act as a non-steroidal anti-inflammatory to help decrease redness and inflammation. We have also included Raspberry Ketone in the formulation for its unique ability to activate sensory neurons in the skin to increase production of IGF-1.

Redness and inflammation are often one of the most complained about aspects of living with Keratosis Pilaris.

Where does the redness in KP come from? Through this study we can see that the impaired skin barrier around the hair follicles allow for bacteria and allergens to traverse through non-lamellar domains (gaps in the skin barrier) due to skin cells not forming a strong, cohesive barrier. When this happens, it triggers an immune response that can result in the blood vessels around the hair follicle dilating. This inflammation (erythema) likely causes the visible redness we see in this condition.

Most over-the-counter treatments for KP use acids to help turn over skin cells and exfoliate away the keratin build up that forms the bumps we see with this condition, but none of them address the redness and inflammation. The acids themselves can cause additional irritation and inflammation as well, especially at higher concentrations.

Addressing redness and inflammation requires a two prong approach to KP. We need to simultaneously address the barrier issues in order to prevent the immune response, and inhibit the cytokine expression to decrease inflammation. This is why Indigo Naturalis is such a promising ingredient in skin care, and why we use it in our U.S. Patent Pending Soothe & Restore Lotion formulation. Indigo Naturalis extract contains indirubin, which has many positive effects on the skin, primarily demonstrating anti-inflammatory and anti-proliferative properties. This has made indirubin a potential treatment option for conditions that need help to regulate the skin cell life cycle and reduce inflammation in skin bumps. in addition to Indigo Naturalis, we have also included Raspberry Ketone for its potential to reduce inflammation and redness. RK stimulates IGF-1 production, which inhibits actions on inflammatory and Th1-mediated cellular immune responses through
stimulation of IL-10 production in T cells. Both of these ingredients in tandem present unique properties that are desirable for reducing redness and inflammation in the skin.

Have you ever heard of PIH (Post Inflammatory Hyperpigmentation)?

PIH is the increased pigmentation or discoloration around the hair follicle after the erythema (inflammation) has dissipated. This is often more common in darker skin tones.

PIH is very difficult to treat and typically will resolve itself over a long period of time as the skin regenerates. One of the best ways to avoid PIH is to stop the inflammation from happening from the get-go, there for preventing the later hyperpigmentation and allowing the current PIH to resolve.

Curled or brittle vellus hairs (the light hairs on your body) are a common KP symptom. Sometimes the hairs will curl or become trapped in the follicular canal, causing additional irritation.

Our hair follicles require sebum (skin oil) to maintain healthy growth. Sebum lubricates the follicle and prevents the hair from becoming brittle. However, seeing that sebaceous gland atrophy is another key symptom of KP, when your skin loses sebum production it can lead to irregular growth of the hair follicle.

In Keratosis Pilaris Atrophicans Faciei (KPAF), also known as ulerythema ophryogenes, these symptoms can be even more pronounced along the eyebrows. These affected hair follicles can be observed to thin or even result in significant hair loss along the eyebrows.

Further insight into these subtypes can be found here and here.

Keratosis Pilaris can be tricky to diagnose since there are multiple ways it appears on the skin. You may see flesh colored bumps, red bumps, dotted and inflamed skin, or a mixture of different symptoms that can affect the body or the face. Some less common subtypes of KP are also recognized by the following names and symptoms:

• KPRF (Keratosis Pilaris Rubra Faciei) is a subtype of KP that affects the cheeks/significant facial involvement. Although KPRF does not typically exhibit the hyperpigmentation or atrophy associated with other KP variants, it does appear to be more common than them but less common than KP, with one study reporting KPRF in up to 25% of patients with KP studied. KPRF prominent symptoms include flushing of the skin and increased erythema across the face.
• KPAF (Keratosis Pilaris Atrophicans Faciei) also known as ulerythema ophryogenes, is a disorder characterized by altered follicular keratinization and inflammation on the cheeks, forehead, chin and eyebrows. It is often followed by a gradual hair loss on the lateral margins of the eyebrows.