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In 2018, he co-wrote and starred in a Sky 1 scripted sitcom called Sick of It.

In 2014, Pilkington designed and signed his own card for UK charity Thomas Coram Foundation for Children. The campaign was launched by crafting company Stampin' Up! UK, and his card, along with those designed and signed by other celebrities, was auctioned off on eBay in May 2014.

In 2013–2015, he starred in a two-series Sky 1 documentary called The Moaning of Life.

Pilkington gained prominence as the producer of Ricky Gervais and Stephen Merchant's radio programme on XFM. He appeared on The Ricky Gervais Show, presented the Sky travel comedy series An Idiot Abroad, and made his full acting debut (following a cameo appearance in the final episode of Extras) on Gervais's 2012 comedy–drama series Derek. Pilkington is a co-founder, along with Gervais and Merchant, of RiSK Productions, a television production company. Pilkington also starred in the Sky 1 travel documentary comedy series The Moaning of Life (2013–2015). In 2018, Pilkington starred in a new scripted comedy series, Sick of It.

He made his acting debut on 12 April 2012 in the Channel 4 comedy-drama Derek, portraying caretaker and bus driver Dougie. He left the show after the first episode of the second series.

Following the success of the first series, Pilkington starred in the second series subtitled The Bucket List, which debuted on 23 September 2011 on Sky 1. The premise of the series involves Pilkington trying to experience "ultimate things to do before you die" except that the list of activities is not entirely of his choosing. In June 2011, he won the Best Presenter award for An Idiot Abroad at the Factual Entertainment Awards. The third series of the show, An Idiot Abroad: The Short Way Round premiered in November 2012 and showed Pilkington and Warwick Davis travelling the Marco Polo route.

On 23 November 2010, while appearing live on Richard Bacon's Radio 5 Live afternoon show, Gervais surprised Pilkington with an on-air phone call. This led to a conversation where Pilkington, who claimed to have been interrupted while grouting his kitchen, said he had not yet been paid for his work on An Idiot Abroad and concluded the interview with an off-the-cuff link into the hourly news.

In September 2010, Pilkington presented An Idiot Abroad, a light-hearted travel documentary series that aired on Sky1 and that was produced by Gervais and Stephen Merchant, in which he visits the New 7 Wonders of the World while being directed by Gervais and Merchant into various activities along the way. He wrote a book to accompany the series.

Pilkington moved to London from Manchester to work with XFM as a producer, where he was later promoted to head of production. While there, he unintentionally caused Gail Porter to leave the station in tears after only one show; he criticised her performance, which Pilkington defended as an attempt to encourage improvement. After several years he began work on The Ricky Gervais Show. Initially, Pilkington was solely the programme's producer. As Gervais and Merchant began to frequently invite him to make a cameo appearance, Pilkington's quirky persona came to light and his popularity increased. Pilkington was eventually included as a main presenter of the broadcasts, with large amounts of airtime devoted to his unusual thoughts on various subjects, or various childhood stories. In December 2005, Pilkington stood in for two BBC 6 Music shows for Nemone, and co-presented the shows with Russell Brand.

Pilkington has been in a long-term relationship with Suzanne Whiston, a former producer at the BBC, since the 1990s. He has supported Manchester United since the 1990s, having previously supported Manchester City as a child.

Karl Pilkington (born 23 September 1972) is an English television presenter, author, comedian, radio producer, actor and voice actor.

Pilkington was born in 1972 in Manchester. He grew up on a Manchester council estate along with his siblings, and attended Ashton on Mersey Secondary School on Cecil Avenue, Sale.