Why Does Keratosis Pilaris Look Different on the Face Than on the Body?

Keratosis Pilaris is a super common skin condition that is due to hair follicles being plugged up by scale from dry skin. This is due to ‘abnormal keratinisation’ of the upper portion of the hair follicle so that the scale fills the follicle instead of ‘exfoliating’ away as it normally should.

It is an extremely common skin condition and most often is seen on the upper arms and thighs. It often appears to be red little dots and feels rough or bumpy to touch.

And it can also happen on the face but it looks different. You may still feel the rough or bumpy texture but you may not appreciate the individual little follicles as dots the way you do on your arms or thighs. That’s because on the thigh and upper arm there are about 40 hair follicles per square centimetre so the little dots are each distinct and so is the redness surrounding each follicle. On the face the hair density increases to 300 follicles per square centimetre! That’s when the redness around each hair follicle looks ‘confluent’ meaning all the redness blends together. When it happens on the face it tends to be on the sides of the face (the cheeks).

What’s the best treatment? A keratolytic agent – tretinoin can help but this is where alpha hydroxy acids like glycolic acid are extremely useful.

Go for the highest strength you can tolerate – my patients generally use up to 15% glycolic in an emollient-type base for both face and body to help smooth the skin surface and clear keratosis pilaris. It takes time and consistency as well as long-term maintenance.