Keratosis Pilaris (Chicken Skin)

Keratosis pilaris are small bumps (goose bumps, chicken skin) appearing on upper arms or other parts of the body (1). Sheded skin cells, instead of falling off, build up in hair follicles and plug them, thus causing skin bumps. Condition is hereditaryand pretty common. It may appear in babies, usually becomes apparent in adolescents, and tends to improve with age. It may be associated with dry skin, ingrown hair, or rarely, atopic dermatitis.

Symptoms:

  • Small, hard, skin-colored, red, or brown bumps on outer and back side of upper arms (Picture 1), thighs, cheeks, upper back, or other parts of the body, giving a chicken skin or goose bumps appearance
  • Bumps may (rarely) itch
  • Bumps are aggravated by cold weather and may clear up in summer
  • Several types of keratosis pilaris, occurring on eyebrows, scalp, and other body parts exist (1)

Keratosis pilaris, chicken skin

Picture 1. Thickened hair follicles in keratosis pilaris.
(source: Samuel Freire da Silva, M.D., atlasdermatologico)

Treatment (won’t cure the condition completely) (2):

  • Moisturizing creams containing urea, salicylic or lactic acid, or tretionine
  • Rubbing with a pumice stone in the shower
  • Exfoliants (ointments that cause skin peeling) like retinoids (should be not used in pregnancy and in babies)
  • Laser assisted hair removal
  • Acne removal with a needle, chemical peels, microdermabrasion, blue-light, laser, and intense pulsed light devices

Treatment has to be continuous, since the skin thickening in keratosis pilaris is a continuous process.

 

 

“Upper Arm Acne”

Red bumps with occasional white centers, that may appear on shoulders and upper arms (but also on face, back, buttocks and thighs), may represent:

 


 

Brachioradial Pruritis (BRP) - Itchy Upper Arm Syndrome

Brachioradial pruritus (once called itchy upper arm syndrome) is an intense itch appearing on the back and outer parts of the arm (1). The exact cause is not known, but damage of nerves in sun exposed skin was observed. Age related deformations of bonny tissue in neck spine that compress on nerves that supply the arm can be sometimes found. Disorder has not been found in individuals below 18 years of age so far.

Symptoms (4,5):

  • Itchy, burning, or tingling sensation on sun exposed parts of the upper arm, forearm or/and shoulders (but not on other parts of the body). One or both arms may be affected.
  • Itch is especially prominent at night
  • No rash is usually present
  • Symptoms correlate with direct sun exposure and often disappear in winter
  • Symptoms may last from several weeks to several years

Diagnosis. Skin biopsy, where a small part of skin is examined under the microscope may show damaged skin nerves and reduced skin tissue (skin atrophy).

Treatment options (3):

  • Ice cubs or cold wet clothes placed over affected area almost always help
  • Topical capsaicin may provide temporary relief
  • Antihistamines or tricyclic antidepressants by mouth may help affected person sleep
  • Chiropractor may help to persons with spine related disorder
  • Acupuncture was shown to be effective in some cases

Prevention is in wearing long-sleeved shirts, avoiding sun between 10 am and 2 pm, using sunscreens, and avoiding scratching.

 


 

Pompholyx

Pompholyx (vesicular or dyshidrotic eczema) is a common type of skin inflammation with blisters, affecting the hands and/or feet. The exact cause is not known; it’s often connected with sweaty palms (palmar hyperhidrosis).

Symptoms:

  • Wet blisters, dry red bumps, swollen skin around the nails, or cracks may appear on hands, fingers and sometimes on feet or toes
  • Prominent itching

Symptoms are aggravated by irritant substances, like detergents or solvents.

Pomphylox

Picture 2.Pompholyx, dyshidrotic eczema on the palm.
(source: Samuel Freire da Silva, M.D., atlasdermatologico)

Treatment is rarely completely effective.

  • To dry up the blisters, Burrow’s solution (aluminium acetate), or 1% vinegar are applied for 15 minutes four times a day
  • In dry skin, moisturizing cremes should be used
  • In intense inflammation, short term (up to 14 days) corticosteroids (as moisturizer, or taken by mouth) are effective, but condition may reoccur shortly after stopping treatment
  • If staph skin infection appears it should be treated with appropriate antibiotics
  • PUVA therapy with ultraviolet light usually helps

 

 

Hand Dermatitis

Contact dermatitis may be triggered by prolonged exposure to irritant substances such as detergents, solvents, or car oil.

Allergic dermatitis may occur 48-72 hours after exposure to substances that can cause allergy: PPD in hair dyes, rubber accelerators in gloves, nickel in jewelry and metal closures on cloth, chromates  in shoe leather, antibiotic neomycin, fragrance, lanolin in ointments and cosmetics, formaldehyde (allergic dermatitis), psoriasis, and genetic factors.

Symptoms:

  • Red and dry skin on back or palm side of the hands that can progress to itchy bumps, vesicles, scaling, cracking, weeping or swelling, that may last for several weeks/months or until irritation doesn’t stop
  • Hives, a swollen red patch of skin, may appear in allergies and last about 20 minutes

Diagnosis. Patch skin tests can be performed to distinguish between contact and allergic dermatitis.

Treatment. In prolonged allergy, antihistamines by mouth can be taken. Severe inflammation can be treated with corticosteroids.

Prevention is in avoiding wet work and irritant substances, using gloves (vinyl gloves in allergy to rubber gloves), and moisturizing cremes.

 


 

Palmoplantar Keratoderma

Palmoplantar keratoderma means marked thickening of the skin on palms and/or soles (Picture 3) Thickened skin may itch or not. Condition may be inherited, or related to eczema, psoriasis, infections, medications, toxins, cancer or other internal disease, or circulation disorder.

Palmoplantar keratoderma

Picture 3.Palmoplantar keratoderma on a child’s palm.
(source: Samuel Freire da Silva, M.D., atlasdermatologico)

Treatmentincludes moisturizing cremes, and ointments (containing salicylic acid, vit D, or retinoids) that help in thinning of thickened skin.

 

 

Raynaud’s Disease & Raynaud’s Syndrome

Arterial spasms in Raynaud’s disease and Raynaud’s syndrome may cause itching, tingling, burning, or pain. 

 

Chilblains

Chilblains is cold injury that causes itchy, painful, redish/purplish swelling of fingers (or toes, nose, ears). Chilblains may last for several days and may need several weeks to heal completely. Corticosteroid ointment can be used to reduce swelling. Heparin ointment improves circulation (9). Mild painkillers like Aspirin or paracetamol may be used in pain.

Picture of Chilblains on Fingers

 

 

Itchy Hand Rash

Rare hand rashes:

 

Further Reading:

Itchy Legs
Itchy Feet and Toes

References:

  1. Keratosis pilaris – goose skin  (dermnetnz.org)
  2. Treatment of keratosis pilaris  (emedicine.medscape.com)
  3. Itchy upper arm syndrome – Brachioradial pruritus  (emedicine.medscape.com)
  4. Several reports of brachioradial pruritus  (thedermblog.com)
  5. Reports about arm itch  (skincell.org/community)
  6. Pompholyx  (dermnetnz.org)
  7. Hand dermatitis  (dermnetnz.org)
  8. Palmoplantar keratoderma  (dermnetnz.org)
  9. Chilblains  (epodiatry.com)

Further Reading :
  • Itchy Rash
  • Itchy Rash on the Neck