Sometimes known as ‘chicken skin’, keratosis pilaris is a condition caused by a build-up of keratin in the hair follicles of skin, leading to small bumps, usually on the backs of the upper arms, thighs, and posterior. These bumps, which look a little like permanent gooseflesh or goosepimples, are normally asymptomatic, although some people find that the skin in these areas may be itchy.
Some 50-80% of adolescents and 40% of adults are thought to be affected by keratosis pilaris, and researchers are just beginning to uncover risk factors for the condition (Alai, 2012).
Causes of Keratosis Pilaris
Although there is no confirmed mechanism behind the development of these clusters of raised skin bumps, many people find that coconut oil offers significant relief from keratosis pilaris. For example, keratosis pilaris development has also been linked to the use of certain medications, namely RAF inhibitors sorafenib and vemurafenib and, more recently, erlotinib, an EGFR inhibitor used in the treatment of lung cancer (Okereke et al., 2014).
One recent study also investigated the proposed cause of keratosis pilaris, hyperkeratinisation, and found that this may not be the real root of the skin problem. This study, by Thomas and Khopkar (2012), noted that a large proportion of those with these raised skin bumps have coiled hair shafts that lead to rupture of the follicle’s thin lining of cells. This rupture in the epithelium of the follicle can trigger inflammation that leads to abnormal production of keratin and the formation of a keratin plug. As such, it may not be a direct problem of hyperkeratinisation that causes the keratin plugs to form, but an issue with the hair that leads to hyperkeratinisation.
Treating and Diagnosing Keratosis Pilaris
Treatment options vary for keratosis pilaris, with most focusing on avoiding skin dryness and using keratolytic agents or topical steroids to control hyperkeratinisation. It is important to determine the nature of these skin bumps prior to applying treatments.
People with raised skin bumps that look like keratosis pilaris may undergo tests to rule out a differential diagnosis of: phrynoderma, follicular eczema, follicular lichen planus, juvenile pityriasis rubra pilaris, acne vulgaris, acneiform drug eruption, trichostasis spinulosa, ichthyosis follicularis, scurvy, eruptive vellus hair cysts or perforating folliculitis.
If there is a suspicion that acne is involved it is particularly important to obtain a proper diagnosis as acne is more likely to respond to a salicylic acid lotion, while keratosis pilaris may be exacerbated by the drying effect of such products. For folks looking for a natural remedy for keratosis pilaris (and acne), there is hope: in some cases, both acne and keratosis pilaris can respond well to dietary and lifestyle changes that decrease inflammation and improve circulation and overall skin health.
Causes of Keratosis Pilaris
Genetics may play a role in keratosis pilaris, as may factors such as hyperkeratosis, hypergranulosis, inflammation involving T helper cells, and an absence of sebaceous glands in affected areas (Gruber et al., 2015). Abnormalities in the hair shaft, and also abnormalities in skin barrier function have also been observed, with increased permeability of the interfollicular and follicular stratum corneum correlated with improper maturation and organisation of the extracellular lamellar bilayer (Gruber et al., 2015).
This loss or absence of sebaceous glands in areas affected by keratosis pilaris may be an early stage in the development of the skin condition. A lack of sebum (oil) production could cause dryness of the skin, abnormalities in the hair shaft, and problems with skin cell barrier function that then prompt overproduction of keratin and keratin build-up in the hair follicles. Keratin is also the protein that makes up hair and nails.
Why Coconut Oil for Skin Health?
In one study, coconut juice was found to help improve wound healing in animals, with an apparent increase in the density of sebaceous glands (Radenahmad et al., 2012). In another study, this time in children with atopic dermatitis (AD), coconut oil helped improve the skin’s ability to maintain moisture levels and decreased symptoms of AD; such improvements may also suggest benefits of coconut oil as a natural remedy for keratosis pilaris (Evangelista et al., 2014).
Coconut oil has also been seen to help decrease the incidence of infection in infants (Salam et al., 2015), and to decrease xerosis symptoms including skin dryness, scaling, roughness, and pruritus (Agero & Verallo-Rowell, 2004).
Coconut Oil – A Natural Remedy for Keratosis Pilaris?
This research may explain why coconut oil seems to work for relief of keratosis pilaris. This natural oil helps the body to balance skin moisture levels, preventing skin becoming dry and cracked skin and arguably at higher risk of keratin overproduction and build-up, skin barrier dysfunction, and hair shaft abnormalities.
Coconut oil is a solid fat at room temperature, but quickly softens when rubbed into skin, making it easy to use. It absorbs quickly, without leaving a greasy residue, and is also great for use as a hair conditioner, emergency sunscreen (it has a sun protection factor of around 8), and also as a cooking oil that has a high smoke point. Balanced with healthy omega-3 fats from flaxseed, walnuts, chia and hemp, coconut oil is a great pantry item that also has benefits for skin health including, it seems, keratosis pilaris.
Agero AL, Verallo-Rowell VM. A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis. 2004 Sep;15(3):109-16. https://www.ncbi.nlm.nih.gov/pubmed/15724344
Alai NN. Keratosis pilaris. Emedicine. [Last updated on 2012 Mar 23 2012]. Available from http://emedicine.medscape.com/article/1070651-overview.
Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol. 2014 Jan;53(1):100-8. https://www.ncbi.nlm.nih.gov/pubmed/24320105
Gruber R, Sugarman JL, Crumrine D, Hupe M, Mauro TM, Mauldin EA, Thyssen JP, Brandner JM, Hennies HC, Schmuth M, Elias PM. Sebaceous Gland, Hair Shaft, and Epidermal Barrier Abnormalities in Keratosis Pilaris with and without Filaggrin Deficiency. Am J Pathol. 2015 Apr;185(4):1012-21. https://www.ncbi.nlm.nih.gov/pubmed/25660180
Okereke UR, Colozza S, Cohen DE. A case of new onset keratosis pilaris after discontinuation of erlotinib. J Drugs Dermatol. 2014 Nov;13(11):1410-1. https://www.ncbi.nlm.nih.gov/pubmed/25607711
Radenahmad N, Saleh F, Sayoh I, Sawangjaroen K, Subhadhirasakul P, Boonyoung P, Rundorn W, Mitranun W. Young coconut juice can accelerate the healing process of cutaneous wounds. BMC Complement Altern Med. 2012 Dec 12;12:252. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538627/
Salam RA, Darmstadt GL, Bhutta ZA. Effect of emollient therapy on clinical outcomes in preterm neonates in Pakistan: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2015 Jan 30. pii: fetalneonatal-2014-307157. https://www.ncbi.nlm.nih.gov/pubmed/25637007
Thomas M, Khopkar US. Keratosis pilaris revisited: is it more than just a follicular keratosis? Int J Trichology. 2012 Oct;4(4):255-8. https://www.ncbi.nlm.nih.gov/pubmed/23766609