KERATOSIS PILARIS (KP)
Keratosis Pilaris (KP) appears as regular tiny bumps that make the skin look like chicken skin or goose bumps. It is a common condition, said to affect, worldwide, 50-80% of adolescents, less in younger children, and approximately 40% of adults. These people are genetically predisposed to form the bumps from a build-up of keratin around individual hair follicles. Often there is a hair unable to reach the surface of the KP bump. KP often starts in the first decade of life, worsens in adolescence, then tends to disappear — but not always — in adulthood.
KP is often associated with:
- Dry or xerotic skin,
- Frequently hereditary skin conditions such as ichthyosis vulgaris,
- Atopy affecting the skin (atopic dermatitis, or AD), or the lung in bronchial asthma, or the nasopharynx as in rhinitis.
Children and adults with KP are otherwise healthy and, except for the cosmetic appearance of the skin, suffer no other problems nor symptoms from it.
MANAGEMENT AND TREATMENT: For Children and Adults
Because of this association with skin dryness, and because KP tends to last a long time, making it cosmetically bothersome, treatment can be necessary. As you will notice from the steps below (for both adults and children) treatment and management of KP includes many of the same steps generally suggested for people with xerotic, ichthyotic or atopic skin.
The regular and meticulous care of barrier-compromised dry skin is best started early. This helps minimize acute and chronic flare-ups of the primary condition and the darkening of the skin due to chronicity (the longer the irritation, the higher the chances of post-inflammatory hyperpigmentation), especially in those with darker skin types.
IMPORTANT: Because KP can be complex and difficult to treat, with different treatments being more or less successful for different patients, it is best to work closely with your dermatologist.
DAILY KP CARE and MANAGEMENT:
1. From Ingredients to Touching and Water: Handle With Care
Physically, always be gentle with the skin. Do not rub or scratch the skin. Do not use a pumice stone, loofah or rough face towel in the shower or bath.
Do not use very hot water. Tepid or even cool water is kinder to skin with KP (and dryness).
Examine ingredients carefully and opt for validated hypoallergenic products that are preservative, fragrance, dye, and allergen-free as possible to help avoid allergic or irritant contact dermatitis which can further compromise barrier integrity.
2. pH Matters: Pay Close Attention to the pH of Your Products
- Check product labeling for mention of pH levels (the closer to the skin’s slightly acidic pH, the better). The normal pH of our skin ranges from 4 to 6.5 with an average of 5.5 (neutral pH is 7; the skin is naturally slightly acidic). At this acid-mantle pH, the skin is able to help protect itself from invading microorganisms. Friendly resident organisms help maintain the homeostasis of the skin by breaking down oil or sebum secreted by or released from our cells, into fatty acids that kill pathogenic microorganisms. Important: the fatty acids also help maintain the skin’s acidic pH which is generally not friendly for microbes. In other words, keeping the skin in its natural acidic pH helps prevent dryness, protect its barrier layer, and prevent infection.
- Use Cream-Type Cleansers; Avoid bar soaps. Bar soaps generally have a high pH (8 to 10) due to the way they are made (alkali needs to be added to the oil in the making of the soaps). They therefore tend to be denaturing and further drying to the skin. Instead, use cream-type cleansers which often have a pH closer to that of normal skin (and possibly additional healthy hydrators).
- Avoid Cleansers with HIGH AMOUNTS of acids, such as salicylic, retinoic, glycolic, that bring the pH to lower than 5-5.5. Small amounts of these ingredients are fine — they may actually help lower a cleanser’s pH level to a slightly more acidic level that is closer to the skin’s own pH level. But too much of these ingredients may make the product too acidic and irritating for skin with KP.
3. Moisturize. Liberally.
Liberally apply moisturizing creams and lotions that ideally have ingredients native to the epidermal barrier layer such as: glycerin, urea, NMF or virgin coconut oil.
Virgin Coconut Oil (VCO) itself as moisturizer, or as an ingredient of moisturizers, is ideal because VCO is broken down into fatty acids that are stable, less vulnerable to oxidation, and are able to passively contribute to the lipid bi-layer of individual cells thus help repair the barrier layer of the skin. VCO also has high amounts of lauric, capric, caprylic, and myristic acids that have anti-microbial properties. Its fatty acids are native to skin, too, making absorption, compatibility and repair ideal. For more, enter “virgin coconut oil” in the search field of skintelligencenter.com.
For adults, adding a salicylic acid-monolaurin lotion prior to these other moisturizers up to 1x- to 2x a day can also help with clarity. See Additional Treatment Options for Adults below for more information.
FOR MORE SEVERE DRY SKIN WITH KP:
1. Baking Soda Soak
A cup of baking soda in tepid water in a bathtub is a good soak to quickly soften thick, dry scales. Immediately follow with an acidic moisturizing lotion (see below for what to look for). The instant softening and improvement of the appearance of KP can make this process well worthwhile. Remember, however, that this alone will probably not provide long-term benefits. It is a good practice for quick relief but sustained improvement is best achieved by prevention and maintenance.
2. Overnight Moisturizing Occlusion
Another treatment for damaged skin: after applying virgin coconut oil or ointment (such as petroleum with another gentle anti-inflammatory like virgin coconut oil and/or monolaurin), do a cling-wrap occlusion overnight (wrap skin in cling-warp over the VCO/balm and leave on overnight) to help trap water, deliver fatty acids and other epidermal skin factors and the anti-inflammatories of VCO to further help restore barrier integrity.
For itchy skin apply anti-inflammatory oils like virgin coconut oil or occlusive oils like petroleum jelly (ideally with another gentle anti-inflammatory like virgin coconut oil and/or monolaurin) that help trap water in the epidermis to help improve its barrier function.
ADDITIONAL TREATMENT OPTIONS FOR ADULTS (with your dermatologist):
Ask your doctor about the following possible treatments which have been shown to be effective for KP.
1. Acute Episodes/Flare-Ups.
For inflammatory flare ups of KP, dermatologists may prescribe topical steroids. These are used sparingly to avoid side effects from chronic steroid use (skin thinning, lowered resistance to microbial invasion, etc.). Non-steroidal anti-inflammatory topical such as pimecrolimus and tacrolimus may also be prescribed.
Alternative non-steroidal anti-inflammatory ointments might also be considered.
Proper daily maintenance and prevention could reduce the risk for steroids to as little as 2-3 times a year.
2. Topical Retinoids (not when pregnant)
Topical retinoids: gels or creams available by prescription can help exfoliate or peel off the keratin buildup and help lighten skin darkening. For the first few weeks of treatment, redness and peeling of the treated areas can be very irritating and may even contribute to further skin dryness. Topical retinoids are not suitable for young children and must not be used in pregnancy.
3. Topical Salicylic Acid (not when pregnant) or Glycolic Acid
Particularly with an anti-inflammatory like monolaurin, a salicylic acid moisturizer (being oil-souble) applied 1x- to 2x-a-day (instead of or prior to other moisturizers mentioned above) can help reduce the inflammation that can occasionally surround the keratotic follicle of KP.
Especially when used over a longer period of time, salicylic or glycolic acids at low doses or used infrequently and as tolerated can be very helpful in reducing the keratin buildup at the pores as well as to lessen the pigmentation that is often seen in KP. Their application should be done slowly and carefully. Rushing their application or using products with allergens or irritants in the formulation may make it difficult to use them over an extended period of time, which is when their effectiveness is best seen.
4. Pulse Dye Laser Treatment or Intense Pulsed Light (IPL):
These may reduce the redness (at least temporarily), but not the roughness, of KP.
Laser assisted hair removal may also be of benefit in some cases.
An M.D. Article Contribution. At Skintelligencenter.com, we include articles contributed by doctors who wish to provide helpful information to their patients and the public at large, or who respond to our requests to use them as professional resources. Doctors may or may not prefer to remain anonymous and we respect this preferences. These resource articles do not in any way imply an endorsement by the physician of Skintelligencenter or VMV HYPOALLERGENICS®—they are intended for informational purposes only. While written by or with resource professionals, these articles should not be relied on for diagnostic accuracy or applicability to your particular skin, which requires an in-person ocular consultation with a qualified physician. For appropriate care for your skin, please consult your dermatologist.
Articles contributed by doctors do not normally contain product recommendations for ethical reasons, and we at VMV HYPOALLERGENICS® believe in protecting the skintegrity of our resource physicians. Below are some products that we at Skintelligencenter.com feel can be recommended based on the preceding article. They are our “skinformed” selections based on the information given above and not necessarily recommended by the medical author of the article.
For Moisturizing (for the face and body):
Acute Episodes, Flare-Ups, Itching:
- Grandma Minnie’s The Big, Brave Boo-Boo Balm may already work for many people, and would be ideal for babies very young children.
- As a next step, try Red Better Daily Therapy Moisturizer as this may already be adequate to reduce the itching and inflammation. For children, limit to a dot or two at application, and spread gently.
- To try before reaching for the steroid, try steroid-free Red Better Flare-Up Balm.
- NOTE: Follow your doctor’s instructions. Steroids and other medications are important to use when absolutely necessary and prescribed by your doctor. The suggestions above are intended to provide you with options for cases where a non-steroidal option might be already effective, and for more regular use.
Sun and Light Protection:
- Armada Post-Procedure Barrier Cream 50+, a chemical sunscreen-free (organic sunscreen-free) sun and light screen for indoor and outdoor use. Doubles as a physical barrier cream to help prevent contact irritations. Subtly tinted green with safe mineral pigments to help cancel out redness.
- Armada Baby 50+: a chemical sunscreen-free (organic sunscreen-free) sun and light screen for indoor and outdoor use.
Click here for more on very dry, flaking skin.
Click here for more on how hypoallergenicity can help dry skin.
Click here for more on patch tests.
Click here for more on the VH-Rating System for validating hypoallergenicity.