Amy Burkhart, MD, RD
Amy Burkhart, MD, RD, is a board-certified emergency medicine physician and registered dietitian. She also trained in integrative medicine with Dr. Andrew Weil at the University of Arizona Center for Integrative Medicine. Her practice is located in Napa, CA.
1100 Lincoln Ave. Suite 200
Napa, CA 94558
(707) 927-5622 Office
www.TheCeliacMD.com
According to “Dr. Google,” the tiny bumps popularly known as “ chicken skin” that occur on the backs of arms and on cheeks and thighs can be cured by eliminating gluten from the diet. Is there truth to that claim or is it yet another Internet myth? Found in up to 50% of the world’s population, and known in medical terms as keratosis pilaris, these tiny bumps can be cosmetically unappealing but don’t typically cause other symptoms or harm. But their presence can cause significant emotional distress for some, especially at times of flare-ups due to their undesirable cosmetic appearance.
My patients often ask me what causes these common little bumps, if gluten or an allergy is to blame, and how to get rid of them.
Keratosis Pilaris Explained
Keratosis pilaris occurs due to overproduction or build up of keratin, a protective protein found on the skin. The bumps can be surrounded by redness, a sign of inflammation that is also seen when they are examined microscopically. Keratosis pilaris occurs more often in people with eczema or dry skin and gets worse in cold or dry weather. As expected, you will find it associated with other inflammatory conditions such as allergies and asthma.
More common in youth but adults get it too
Keratosis pilaris affects 50-80% of adolescents and up to 40% of adults. It may flare up during puberty and lessen with age. There is a strong genetic component so it often runs in families. Symptoms typically come and go throughout the year. Picking at the bumps will only make them cosmetically more significant and increase scarring and discoloration, leaving them darker.
Causes of Keratosis Pilaris
Although it is known to have a genetic factor, scientists do not know the true cause of keratosis pilaris. It is seen more commonly in inflammatory conditions such as asthma and allergies, and is associated with dry skin, vitamin A and essential fatty acid deficiency. Exacerbations and remissions may occur with times of hormonal change such as pregnancy.
Gluten as a cause
There are no studies indicating a direct correlation between gluten ingestion and keratosis pilaris. However, it can be caused by vitamin A deficiency or essential fatty acid deficiency, both of which can occur with impaired absorption. If you have celiac disease or gluten sensitivity you theoretically might suffer from keratosis pilaris flare-ups if you are consuming gluten and have ongoing inflammation or malabsorption.
Treatment
Hydration and lubrication of the skin is the mainstay of treatment. Mild cases can be treated with over-the-counter lubricating creams, easily found at the drugstore or with an Internet search. There is a laundry list of dermatologic therapies such as alpha-hydroxy creams, retinoic acid therapies and steroids that dermatologists may prescribe and compounded combination therapies that can be formulated. Further specific medications are beyond the scope of this article, but can be found here. For more severe cases, laser therapy and dermabrasion may be used.
Integrative Therapies
The most commonly used integrative therapy is to supplement the diet with omega-3 fatty acids or fish oil. In addition to providing the essential fatty acids that may be lacking, these supplements also have a strong anti-inflammatory effect. Dietary manipulations such as gluten-free or dairy-free, anti-inflammatory, sugar-free, Paleo or various autoimmune diet protocols are often implemented. A variety of ‘gut healing’ regimens are also prescribed, but as with most therapies surrounding keratosis pilaris, there is no evidence to support or refute them.
Topical therapies may include coconut oil, olive oil or vitamin A capsules. Finally, exfoliants such as baking soda, oatmeal, or sugar or salt scrubs are sometimes helpful in reducing keratin build-up. Most people do not seek treatment for keratosis pilaris unless it is cosmetically significant, so home therapies are a popular approach.
Diet
Despite the lack of studies indicating a correlation between diet and keratosis pilaris, aside from the aforementioned vitamin A and EFA deficiency, there are many anecdotal reports, including from my patients, of improvement with dietary manipulation. Increasing essential fatty acid intake by consuming more coldwater fish such as sardines, mackerel and salmon may bring improvement. Walnuts are a great vegan source of essential fatty acids.
Food for thought
Although I have seen patients in my office improve their keratosis pilaris with gluten elimination, there is no evidence that everyone who suffers from it would benefit by avoiding gluten. It would be interesting to see a scientific study exploring whether there is a direct correlation between gluten consumption and keratosis pilaris, but since there are no known long-term health consequences of the condition, it may be low on the priority list for research funding. If a patient has been appropriately tested for celiac disease, however, a trial of a gluten-free diet is harmless as long as adequate nutritional intake is maintained.
Because keratosis pilaris is inflammatory in nature it also makes sense that anti-inflammatory diet protocols and lifestyle changes such as stress reduction, mindfulness techniques and proper sleep hygiene would have a positive effect on remission. While it is unlikely anyone will be rushing to do those studies soon, there is no reason that you can not implement changes to decrease inflammation on your own. It may just have the additional benefit of improving your keratosis pilaris.
