Keratosis Pilaris (cont.)
How do I treat keratosis pilaris?
Many treatment options and skin-care
recipes are available for controlling the symptoms of KP. Many patients have
very good temporary improvement following a regular skin-care program of
lubrication. As a general rule of thumb, treatment needs to be continuous. Since
there is no available cure or universally effective treatment for KP, the list
of potential lotions and creams is long. It is important to keep in mind that as
with any condition, no therapy is uniformly effective in all people. Complete
clearing may not be possible. In some cases, KP may also improve or clear
spontaneously without any treatment.
General measures to prevent excessive skin dryness, such as using mild soapless cleansers, are recommended. Frequent skin lubrication is the mainstay of
treatment for nearly all cases. Best results may be achieved with combination
therapy using topical products and physical treatments like gentle exfoliation,
professional manual extraction of whiteheads, facials, microdermabrasion, and
chemical peels.
Sample treatment for a patient with mild to moderate keratosis pilaris:
- Wash
area with Glysal cleanser once a day.
- Pat skin dry.
- Apply Salex or AmLactin
lotion in morning.
- Apply tazarotene (Tazorac) or tretinoin (Retin-A) cream every other night.
- Get a monthly
microdermabrasion and glycolic treatment with physician.
Mild cases of KP may be improved with basic over-the-counter moisturizers
such as Cetaphil or Lubriderm lotions. Additional available therapeutic options
for more difficult cases of KP include lactic-acid lotions (AmLactin,
Lac-Hydrin), alpha-hydroxy-acid lotions (Glytone, glycolic body lotions), urea
cream (Carmol 10, Carmol 20, Carmol 40, Urix 40), salicylic acid (Salex lotion),
and topical steroid creams (triamcinolone 0.1%, Locoid Lipocream), retinoic-acid
products like Retin-A, Tazorac, and adapalene
(Differin). There are also specially mixed "designer" combination, all-in-one
prescription creams with multiple ingredients such as tretinoin 0.1%,
hydroquinone 6%, and fluocinonide 0.05%. Another specially compounded
combination prescription cream is a preparation of 2%-3% salicylic acid in 20%
urea cream. These creams applied once or twice a day help to decrease the
residual dry rough bumps.
The affected area should be washed once or twice a day with a gentle wash
like Cetaphil or Dove. Acne-prone skin may benefit from more therapeutic washes
like Glysal, Proactiv, salicylic acid, or benzoyl peroxide. Lotions should be
gently massaged into the affected area two to three times a day. Irritated or abraded
skin should be treated only with bland moisturizers until the inflammation
resolves.
Occasionally, physicians may prescribe a short seven- to 10-day course of a medium-potency, emollient-based topical steroid cream once or twice a day for inflamed
red areas. Intermittent weekly or biweekly dosing of topical retinoids seem
quite effective and well tolerated, but the response is usually only partial.
After initial clearing with stronger medications, milder maintenance regimens
are used.
Persistent skin discoloration called hyperpigmentation may be treated with
fading creams like prescription-grade hydroquinone 4%, kojic acid, or azelaic
acid 15%-20%. Special compounded creams for particularly resistant skin
discoloration using higher concentrations of hydroquinone 6%, 8%, and 10% may
also be formulated by a compounding pharmacist.
Many treatments have been used in KP without consistent results. As there is
no miraculous cure or universally effective treatment for KP, it is important to
proceed with mild caution and lower expectations.
A menu of available in-office physician or "medspa" performed treatments may
be helpful as adjunctive treatment. Options include various chemical peels,
dermabrasion, microdermabrasion, photodynamic therapy (PDT), ALA, Levulan, blue
light, laser, photofacials, and Intense Pulsed Light (IPL). Overall, a
combination of in-office treatments and a physician-directed home-maintenance
skin-care routine is ideal.
Severe cases of KP have been treated with isotretinoin (Accutane) pills for
several months. Accutane is generally a very potent oral medication reserved for
severe, resistant, or scarring cases of acne. Its use in KP would be considered
off-label (not FDA approved) and not routine.
Photodynamic therapy with aminolevulinic acid (Levulan) has been anecdotally
reported as effective, but this successful use of off-label photodynamic therapy
requires further trials.
Microdermabrasion is a safe, minimally invasive, in-office procedure whereby
the skin is gently exfoliated. Using vacuum-assisted suction, the skin is rubbed
with an abrasive particle such as fine, powdery aluminum crystals or small
diamond tips. Microdermabrasion assists in removing the excess keratin and outer
layers of the epidermis (skin) in a controlled manner. As with other treatments
for KP, there are small group observations and anecdotal reports for this
treatment. An option to in-office microdermabrasion is home personal exfoliation
with a loofah sponge or a commercially available Buf-Puf.
KP may also be treated with topical immunomodulators (medications that dampen
or alter the immune system) like pimecrolimus (Elidel) or tacrolimus ointment (Protopic). Although these products are
approved for atopic dermatitis and eczema, their use would be considered off-label for KP. These may be used in more resistant
situations or where there is considerable skin redness or inflammation.
Newer prescription cream such as MimyX and Atopiclair may have an off-label
role in improving the skin-barrier function and dryness in KP. These drugs are
currently FDA-approved for atopic dermatitis.
Although calcipotriol ointment (Dovonex) has been used moderately effectively
in various skin conditions like psoriasis and ichthyosis vulgaris, it has not
had a therapeutic effect for KP in clinical trials.
Because KP is generally a chronic condition requiring long-term maintenance,
most therapies would require repeated or long-term use for optimum results.
Mild cleansers and lotions for sensitive skin: Wash daily, and apply lotion
twice a day.
- Cetaphil
- Dove
- Lubriderm
- Purpose
Potent moisturizers for home treatment: Use once or twice a day.
- Lactic-acid
lotions (AmLactin, Lac-Hydrin)
- Alpha-hydroxy-acid lotions (Glytone, Citrix
glycolic body lotion 15%)
- Urea creams (Carmol 10, Carmol 20, Carmol 40, Urix
40)
- Salicylic-acid lotions (Salex 6%)
- Compounded 3% salicylic acid in 20%
urea cream
Topical retinoids for tougher KP or acne-prone skin: Use nightly or every
other night.
- Tretinoin (Retin-A)
- Tazarotene (Tazorac)
- Adapalene (Differin)
Creams to treat brown spots or hyperpigmentation: Use once or twice a day.
- Hydroquinone 4% (Obagi Clear, Glyquin-XM)
- Kojic acid
- Azelaic acid (Finacea)
- Compounded triple cream with tretinoin 0.1%, hydroquinone 6%, and fluocinonide
0.05%
Physician in-office treatment options: monthly or as per your physician
- Microdermabrasion
- Chemical peels
- Photodynamic therapy (PDT)
- Blue light
- Lasers
- Intense Pulsed Light (IPL)
Next: Keratosis pilaris "do's" »
- tretinoin, Retin A, Atralin, Renova, Avita, Altinac - Learn about tretinoin (Retin-A, Atralin, Renova, Avita, Altinac) a drug used to treat moderate acne, wrinkles, and sun damaged skin.
- Photodynamic Therapy - Read about photodynamic therapy (PDT). PDT uses a photosensitizing agent and light source to treat cancers (skin, lung, esophageal, Barrett's esophagus), acne and rosacea.
- Rash - Learn about rash causes, symptoms, diagnosis and treatment. Common skin rashes include poison ivy, hives, shingles, eczema, contact dermatitis, ringworm, psoriasis and impetigo.
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