Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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:
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%)
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
Allergic rhinitis symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat. Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air. Perennial allergic rhinitis is a type of chronic rhinitis and is a year–round problem, often caused by indoor allergens, such as dust, animal dander, and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependant upon the type of rhinitis condition.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Eczema is a general term for many types dermatitis (skin inflammation). Atopic dermatitis is the most common of the many types of eczema. Other types of eczema include: contact eczema, allergic contact eczema, seborrheic eczema, nummular eczema, stasis dermatitis, and. dyshidrotic eczema.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Scar formation is a natural part of the healing process after injury. The depth and size of the wound incision and the location of the injury impact the scar's characteristics, but your age, heredity and even sex or ethnicity will affect how your skin reacts.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
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