Many individuals describe the presence of small dark dots or a rough texture on their arms or legs as “strawberry skin.” In dermatology, this appearance often relates to follicular keratin plugging, most commonly associated with keratosis pilaris (KP).[1] Evidence shows that KP develops when keratin accumulates within the follicular opening, forming small bumps centred around hair follicles. Research also notes that some people experience perifollicular redness, contributing to the spotted appearance.[2]
Keratosis pilaris develops due to an abnormal pattern of keratinisation. Studies highlight the role of filaggrin (FLG) gene mutations, which affect the skin barrier and increase susceptibility to dryness and atopic conditions.[3] KP may begin in childhood and often becomes more noticeable during adolescence. Worsening during puberty is attributed to increased follicular activity. In many individuals, the bumps may reduce over time, but the pattern may persist depending on skin type, associated conditions, and grooming practices. The dotted appearance that people describe as “strawberry skin” usually reflects the combination of plugged follicles, retained hair fragments, or pigmentation around the follicular opening.[1,2]
Clinically, KP manifests as small, rough, follicle-based bumps measuring 1–2 mm. They typically appear on the upper arms, thighs, or buttocks. The skin often feels coarse due to the accumulation of keratin within the follicle. While the appearance may be concerning for some individuals, scientific literature consistently describes KP and similar follicular patterns as benign with no systemic consequences.
Recent dermatology reviews recommend a structured approach centred on skin-barrier repair, gentle exfoliation, and topical therapy. Daily moisturisation and the use of mild cleansers help minimise dryness that contributes to follicular blockage. Keratolytic agents such as urea-based creams and ammonium lactate smooth the follicular openings by reducing compact keratin.[1]
Topical retinoids may be used when the bumps remain persistent despite basic care. For selected cases, physical procedures such as laser therapy and microdermabrasion are discussed in the literature, although their long-term effectiveness requires further evidence. Emerging research exploring follicular biology and molecular pathways, including Ras signalling, may support future therapeutic avenues.[2]
To understand how these patterns appear in daily practice and how patients can manage them effectively, MedBound Times consulted Dr. Arphool I. Khan, MBBS, MD (Dermatology), Assistant Professor at MPT Medical College, Siddharth Nagar.
Dr. Khan shared his insights on improving skin health, reducing follicular blockage, and adopting effective long-term care practices.
What Causes Strawberry Skin?
Dr. Arphool I. Khan: The pattern may result from broken or ingrown hair, particularly after repeated waxing or shaving against hair growth. The roughness can also occur in keratosis pilaris or folliculitis, both of which involve inflammation or blockage of the follicle.
How to Prevent Strawberry Skin?
Dr. Arphool I. Khan:
a) Regular exfoliation to remove dead skin.
b) Daily moisturisation to maintain hydration.
c) Proper shaving technique, using a sharp razor, shaving in the direction of growth, and always applying a shaving lubricant.
What are some Dermatologist-Recommended Treatments?
Dr. Arphool I. Khan:
a) A moisturiser applied 2–3 times daily.
b) Benzoyl peroxide wash for cases involving folliculitis.
c) Gentle chemical exfoliation using salicylic acid or lactic acid formulations.
When should someone consult a dermatologist?
Dr. Arphool I. Khan: A consultation is appropriate when there is itching or irritation or when symptoms persist.
Is strawberry skin permanent?
Dr. Arphool I. Khan: No, however, ongoing care is needed to maintain improvement.
Is laser hair removal effective for strawberry skin?
Dr. Arphool I. Khan: Yes, Diode laser hair removal offers good long-term improvement, especially for recurrent ingrown hair.
Does chemical exfoliants like AHA or BHA help?
Dr. Arphool I. Khan: Yes. Gentle exfoliation helps reduce dead skin and smoothens the follicular surface.
What precautions should individuals follow?
Dr. Arphool I. Khan:
a) Avoid scratching, plucking, or waxing during flare-ups.
b) Maintain consistent moisturization.
c) Seek dermatology guidance for personalised treatment.
Although strawberry skin is primarily a cosmetic concern, individuals with this presentation may also have associated conditions such as atopic dermatitis or ichthyosis. Recognising these patterns helps clinicians tailor care, identify coexisting conditions, and provide clear guidance about realistic expectations and long-term skin maintenance.
References:
1. Pennycook KB, McCready TA. Keratosis Pilaris. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 31536314.
2. Kodali N, Patel VM, Schwartz RA. Keratosis pilaris: an update and approach to management. Ital J Dermatol Venerol. 2023 Jun;158(3):217-223. doi: 10.23736/S2784-8671.23.07594-1. Epub 2023 May 11. PMID: 37166753.
3. Wang, J.F., Orlow, S.J. Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options. Am J Clin Dermatol 19, 733–757 (2018).
Edited by M Subha Maheswari