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Are Keratosis Pilaris and Psoriasis Related? How They Differ

Posted on May 01, 2023
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Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Sarah Winfrey

Psoriasis shares symptoms with a number of other skin conditions, including keratosis pilaris. They both can present as a rash on the skin, worsen in dry air, and cause itching. Given these overlaps — and the fact that it’s possible to have both conditions at once — it can be difficult to know what’s causing any new skin symptoms you develop.

Psoriasis is an autoimmune condition that occurs when part of the immune system becomes overactive, causing it to make new skin cells faster than usual. These cells accumulate on the surface of the skin and can become thick, itchy, and scaly. It also causes inflammation, which can lead to additional itching and pain.

Keratosis pilaris is a common skin condition that occurs when a protein called keratin builds up inside hair follicles, creating patches of bumpy skin. These areas of buildup may be large or small.

You can have both of these conditions at the same time, but one does not cause the other, and they are not known to be connected.

The differences between psoriasis and keratosis pilaris should be clear to a dermatologist. It may be helpful for you to understand the differences between their symptoms, causes, risk factors, diagnosis, treatment, and management.

Symptoms of Keratosis Pilaris and Psoriasis

Keratosis pilaris symptoms and psoriasis symptoms do have some overlap. Both cause what may appear as a rash with bumps on the skin, and both can get worse under certain conditions, such as when you are in cold and/or dry air. Additionally, both can cause itchiness.

However, that’s where the similarities end.

Psoriasis Symptoms

Plaque psoriasis, the most common type of psoriasis, causes raised, discolored patches on the skin. (CC BY-NC-ND 3.0 NZ/DermNet)

Most of the time, psoriasis looks like discolored, raised patches of skin with scales. The patches are generally pink or red, and the scales are usually silvery white on lighter skin. On darker skin, the patches are often purple with scales that are gray or dark brown. These symptoms can be tiny or can cover large areas of the body. They can occur anywhere, including on the scalp, the fingernails and toenails, and even on the genitals.

Beyond that, psoriasis is likely to have different symptoms based on the type of psoriasis and how severe it is. Symptoms can include a deep itching or burning sensation or dry skin that may crack and bleed. If it affects your fingernails, they may get thick, develop ridges, or become pitted.

Keratosis pilaris may appear as small red, pink, or brownish-black bumps, depending on your skin tone. They may itch, but it’s milder than itching from psoriasis. (CC BY-NC-ND 3.0 NZ/DermNet)

Keratosis Pilaris Symptoms

Keratosis pilaris, on the other hand, looks like small bumps that almost look like goose bumps or chicken skin. They can vary in color, including being the same color as your skin. On darker skin, they may be brownish black, and on fairer skin, they may be white, red, or pinkish purple. These symptoms are most likely to develop on the top of your thighs, your buttocks, or on the back of your upper arms — though they can appear in other locations, too.

While keratosis pilaris can itch, it is not usually the deep, burning itching that often comes with psoriasis. Your skin may be dry with keratosis pilaris, but it’s unlikely to develop deep cracks and bleed, and any discoloration is mild.

Causes and Risk Factors of Keratosis Pilaris and Psoriasis

Psoriasis, being an autoimmune condition, arises when part of the immune system becomes overactive. This causes the skin cells to replicate more quickly. However, researchers do not yet know why the immune system becomes dysregulated. It appears that both genetics and environmental factors play a role in causing the condition.

People are more likely to develop psoriasis if others in their family have the condition. Smoking seems to increase the risk of developing psoriasis and can worsen the condition over time.

The exact cause of keratosis pilaris is also unknown. Genetics seem to play a role, but scientists don’t know which genes cause the condition or increase a person’s chances of developing it. It may also be connected to a deficiency of vitamin A in the body. It may also have to do with the shape of the hair follicle shaft, which is likely determined by genetics.

Risk factors for keratosis pilaris include:

  • Having family members with the condition
  • Having asthma, atopic dermatitis (the most common subtype of eczema), or allergies
  • Having dry skin
  • Having a higher body weight

Taking certain medications that treat melanoma, a skin cancer, may also contribute to developing keratosis pilaris. Keratosis pilaris tends to show up either in children under the age of 2 or in teenagers, and may last into the 20s and 30s. It usually disappears in older adults.

There’s no indication that keratosis pilaris and psoriasis are connected in any way. Being diagnosed with one does not put you at a higher risk for being diagnosed with the other. While genetics seem to play a role in both conditions, different genes are likely involved.

Diagnosis of Keratosis Pilaris and Psoriasis

Most doctors and dermatologists will be able to diagnose you with either keratosis pilaris or psoriasis simply by examining your skin. Since these conditions have distinctive appearances, most of these professionals know what they’re looking at when they see it.

Your health care provider may also take a comprehensive health history before they make their diagnosis. This can help them make sure they aren’t missing anything. It can also help them screen for other diagnoses, like the ones mentioned above, that can be risk factors for keratosis pilaris.

In the case of psoriasis, your dermatologist may choose to take a biopsy, which entails removing a skin sample for examination in a lab. This procedure can verify a diagnosis. A biopsy usually isn’t necessary for diagnosing keratosis pilaris.

Treatment and Management of Keratosis Pilaris and Psoriasis

There’s some overlap between the treatment options for keratosis pilaris, though each condition has its own specific treatments, too.

If you have been diagnosed with both conditions, talk to your doctor about whether you can use one of the overlapping treatments or if you need to treat each one separately. The answer may depend on the type and severity of your psoriasis.

Treating Keratosis Pilaris

Keratosis pilaris almost always goes away on its own. If it’s not bothering you, you don’t need to do anything to treat it.

If it is bothering you or you are concerned about how dry your skin is, you can use an over-the-counter moisturizer or lotion from the skin care section of your local retail store and see if that helps. If it doesn’t, your dermatology team should be able to come up with another treatment plan for you.

Most likely, they will give you a moisturizer with urea or lactic acid — either ingredient is usually effective at treating keratosis pilaris. Apply it several times a day to alleviate the dryness.

If the bumps are bothering you, you may need to start by exfoliating your skin — that is, removing dead skin cells from your skin’s outer layer. You’ll also be given a topical cream containing one or more of the following:

  • Lactic acid
  • Urea
  • Salicylic acid
  • Glycolic acid
  • Alpha hydroxy acid
  • A topical retinoid (a cream with vitamin A)

You should apply any cream as directed by your doctor.

If those treatments don’t work for you, your doctor may prescribe laser treatments and/or light treatments. These help alleviate any discoloration in your bumps and smooth the texture of your skin, too.

Your doctor will help guide you to the treatment that is best, given the specifics of your skin.

Treating Psoriasis

There are a lot of options when it comes to treating psoriasis. Most doctors start with topical treatments.

Some of these treatments overlap with those for keratosis pilaris. Specifically, you may be given retinoids or creams with salicylic acid to help treat psoriasis.

However, you have other topical options for psoriasis that are not usually given for keratosis pilaris. These include:

  • Corticosteroid creams
  • Synthetic vitamin D (which may be used with corticosteroids)
  • Coal tar, which can be in creams, shampoos, and oils
  • Calcineurin inhibitors
  • Tapinarof
  • Roflumilast

If these treatments don’t work for you or if you have regular psoriasis flare-ups, your doctor may recommend adding light treatment to your topical regimen. This can also overlap with treatment for keratosis pilaris, though the types of lights used may be different depending on what your doctor thinks will work for you.

Finally, there are other medication options for treating moderate to severe psoriasis, or psoriasis that doesn’t respond to other treatment options. These do not overlap with treatments for keratosis pilaris at all, and they include:

  • Steroids, which are related to corticosteroid creams but are taken orally instead
  • Biologics, which help suppress parts of your immune system that contribute to psoriasis
  • Methotrexate, which helps suppress inflammation
  • Retinoids, which are related to topical retinoids but work throughout the body

If you can’t take any of the medications above, there are other options that may help with psoriasis in a variety of different ways.

Talk to your doctor about the treatment that’s right for you, and then stick with it and see if your psoriasis gets better.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis, and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Are you living with both keratosis pilaris and psoriasis, or are you trying to get diagnosed with either condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on May 01, 2023
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    All updates must be accompanied by text or a picture.
    Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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