Keratosis Pilaris - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Keratosis Pilaris or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Keratosis Pilaris
Keratosis pilaris is a common, benign skin condition characterized by the appearance of multiple small firm skin-colored bumps on the lateral aspect of the upper arms and sometimes thighs. There can be surrounding redness. The bumps can resemble goosebumps and are sometimes referred to by the lay population as "chicken skin". They can cause the skin to have a sandpapery feel when touched. These bumps can also be seen on the face along the outer cheeks of children.
The asymptomatic bumps occur due to the harmless buildup of keratin in hair follicles. The condition usually improves with age and is a trait that is often seen in multiple family members. About 10% of the population carries this trait but there is an increased incidence in people with eczema (atopic dermatitis).
Diagnosis
The diagnosis of keratosis pilaris is easily made by a dermatologist based on its appearance. No biopsy is necessary. The diagnosis is further supported by obtaining a history of other family members with a similar condition.
Management
Treatment is not necessary but patients often seek treatment because of the rough feel, the bumpy appearance of the skin, or the accompanying redness. The appearance and texture can be improved with the use of a topical moisturizing lotion that contains filaggrin-like peptides and ceramides (Cetaphil Restoraderm) or topical keratolytic such as moisturizing lotions that contain citric acid, alpha hydroxy acid (e.g. Eucerin plus lotion or cream), ammonium lactate (e.g. AmLactin 5% lotion or cream) or urea (e.g. Ureacin 10% lotion).
These lotions are readily available over the counter without a prescription. Roughness and bumps reduce significantly after about 2 weeks with regular twice-daily use. If improvement is not seen with these medicated moisturizers, a higher strength of these ingredients or prescription topical retinoids, which are commonly used for acne treatment, can be applied. Gentle physical exfoliation can also be performed for resistant lesions through in-office microdermabrasion.
It is important to know that lotions need to be used regularly to keep the condition under control; if the lotions are stopped the bumps will become prominent with a delay of about 2 weeks. Redness usually reduces at the same time as the skin becomes smooth but if it persists, pulsed dye laser treatment may be pursued. Several sessions spaced 4 weeks apart are often necessary to completely remove redness. Results are long-lasting.
Coping
Most people are assured by understanding the benign nature of the condition. However, when the appearance of these bumps or surrounding redness is disturbing, treatment may be started. Many will treat during the warmer months of the year when they wear short sleeves or in anticipation of an important event. In such cases, treatment should begin at least 2 weeks prior to the date.
Some people will employ aggressive measures to remove the bumps of keratosis pilaris such as through the use of a loofah sponge or through picking. Not only are they rarely effective, but they are also discouraged due to the risk of skin irritation.
Prevention
Keratosis pilaris is an inherited trait, therefore prevention is not possible at this time.
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I have keritosis pilaris on the backs for my upper arms and my thighs. I’ve tried many products like KP Duty and Lac-Hydron, etc. My skin is smoother but the redness remains. Is there something to get rid of the redness?
Thank you.
Keratosis pilaris is a benign genetic trait affecting the skin of 10% of the population. It can occur in childhood but most often becomes apparent in adolescence. It shows as rough, red or pink hair follicles on the back of the arms, which are most commonly affected, although the back, thighs, and sides of the cheeks may also show these changes. Treatment is cosmetic as it is typically asymptomatic. Eucerin plus cream with 4% alpha hydroxy acid, LacHydrin or AmLactin cream with 12% lactic acid may be used and if effective will smoothen the skin after 2 weeks. If not sufficiently softened after 2 weeks, formulations containing 17% glycolic acid or higher such as keratosis pilaris kit by Glytone or other vendors and even Problem Dry Skin by Neostrata can be applied. The key in reducing the rough hair follicles is continuous treatment. Once treatment is discontinued, the trait recurs.
In some people, redness or pinkishness around hair follicles persist despite meticulous and continuous treatment, which has rendered the skin very smooth. Under these circumstances, redness reduction through pulsed dye laser treatments is appropriate. It appears that you fit the latter approach.
I am 26 yrs old and have been treated for KP for years unsuccessfully. I have read about the Icolasz laser being successful in this treatment. Would be able to perform this laser treatment on me? I live in Richmond, but will be in northern Maryland where my family lives and would definitely make the trip. I have not been able to locate someone who is familiar with this in Richmond. (My sister went to Villanova so we are very familiary with the area.) Thank you.
Unfortunately, I have no experience with the efficacy of Isolaz on keratosis pilaris and therefore do not offer it. In contrast, pulsed dye laser treatments to reduce redness in conjunction with Cetaphil Restoraderm daily to soften the skin seems to be working much better than any of the keratosis pilaris kits or combinations with retinoids.
Dr Ringpfeil, does hair removal improve skin texture and appearance for people with keratosis pilaris?
A number of peer reviewed articles suggest that alexandrite laser, puldes dye laser, Nd:YAG laser and IPL can improve keratosis pilaris and related traits. Hair removal is performed with alexandrite, Nd:YAG and diode lasers (sometimes with IPL) and therefore there is a chance that laser assisted hair reduction in an area that has keratosis pilaris will soften the texture. In my experience many people with keratosis pilaris do not have undesired dark hair in these areas however if you fulfill these criteria you may expect textural improvement as a side effect.
Dr. Ringpfeil, I am hoping you can examine and help treat my 17 year old daughter. She has Type 1 Diabetes. She has extremely dry skin and she has now developed fairly extreme keratosis pilaris. I live in Bucks County, PA. I took her to a local derm here that really was not able to help. We tried AmLactin, but her skin became extremely irritated, itchy and red- and she did not seem to be able to tolerate it.
She also had some skin issues on her legs this past summer as well- that no one could figure out what they were- I did take her for that to CHOP.
I would like someone to help her with a regimen for her skin, but also would be open to laser treatments or other options if they could help. Can you let me know if you think you could assess her and help.
Thanks
Management of keratosis pilaris is not always straightforward. In our experience, Cetaphil Restoraderm Lotion works in the majority of those who desire to treat their skin. Alpha-hydroxy acids such as lactic acid or glycolic acid can sometimes be helpful, too but I find that they cause some irritation in higher concentrations in younger individuals. If Cetaphil Restoraderm fails to smooth the skin after 2 week of once daily use, addition of an 8% glycolic acdid cream (AquaGlycolic Face cream in children and teenagers or AquaGlycolic body lotion beyond teenage years) might be advantageous. Urea 10% cream might be another consideration (Excipial 10% Urea Hydrating Healing Lotion).
Our dermatologists at the the Center City or Haverford location are highly skilled and uniformely provide the quality care the name stands for. They will be happy to see your daughter for a personalized consultation for this and any other concerns. You may schedule the appointment online on our website or by callings us.
I am facing with for several years(9 years). I have it all over the body on my back, hands, buttocks and shoulders. I am a professional working from 9-5. Is there some laser treatments which you guys are offering and I also would like to know the cost of it.
There is unfortunately not yet a known cure for keratosis pilaris and there are no lasers that works for it. In about 30-40% with keratosis pilaris, daily application of profillagrin (Cetaphil Restoraderm lotion) will make a difference. This is an engineered lotion and is different from regular Cetaphil cream.
Hello,
I an African American & have KP on my legs (thigh to ankle) so I have little dark dots all over my legs. I guess that’s buildup? Will using the Cetaphil Restoraderm get rid of tha buildup/cause the dots to go away? Aesthetically it drives me nuts during the summer when wearing shorts etc. & I’d like to be rid of them. Thank you!
Dark spot on thighs and legs can be keratosis pilaris or acanthosis nigricans. Without biopsy, it is hard to rule out the latter. If you have risk factors for diabetes, you should be monitored by your family doctor.
regardless of diagnosis, it is reasonable to apply Cetaphil Restoraderm or AquaGlycolic Lotion (Mederma AG Lotion), or a combination of both, one in the morning and the other at night. If you have achieved results after 2 weeks, simply continue the regimen.