New Hope for Keratosis Pilaris
KP is a plug in a hair follicle â€“ what we know as a pore â€“ that becomes inflamed. Sound familiar? Thatâ€™s because KP and acne (which also occurs in the follicle) share a common foe; hyperkeratinization, that is, excessive amounts of the protein keratin from the accelerated shedding of dead skin cells that result in sticky-to-hardened pore-clogging plugs. Aside from location, the major difference is that acne also involves the overproduction of sebum (oil) and p. acnes bacteria whereas KP does not.
Chronic not curable
Sometimes KP clears up on its own, sometimes it doesnâ€™t. Unfortunately, KP is a chronic condition and as such cannot be cured. In the past, a chronic skin disease meant that your complexion was at the mercy of the condition with the symptoms right out there for all to see. You just had to live with it and suffer. Not so today.
In dermatology, one of the most exciting breakthroughs Iâ€™ve witnessed in the last 5 years is that more and more chronic skin conditions can now be managed and successfully so. In increasing numbers of instances we can treat these cases so that their symptoms disappear and become invisible to the naked eye. For example, I have patients who are prone to acne or rosacea â€“ common chronic conditions like KP that are technically â€˜uncurableâ€™ â€“ who have flawless-looking skin.
But slack off and leave out any of the above even for a little while and all bets are off; the symptoms will come roaring back because the underlying causes are still there.
So what to do about KP?
KP is notoriously difficult to treat because the hardened plugs of keratin actually prevent beneficial medicines from penetrating and getting to work where theyâ€™re needed. So the first order of business is to get those plugs up and out of the pore.
A partial but significant solution appeared in this summerâ€™s Journal of Drugs in Dermatology by Heather Ciliberto MD using the IsolazÂ®. Isolaz, FDA-approved for acne treatment, is actually a two-modality device. First, a special treatment tip literally vacuums the pore â€“ sucking up dirt, sebum and skin cell debris closer to the surface â€“ and is then followed by broadband light that destroys the bacteria while sloughing the oils and dead skin cells away. Dr. Cilibertoâ€™s idea was to test the Isolaz on KP. The average improvement was about 50% in redness and roughness a month after treatment, encouraging results.
To my mind, this KP-prone pore emptied of its plug is going to be far more receptive of palliative and exfoliating topicals that can dissolve the sticky hyperkeratinization before it has a chance to harden into a plug.
A stubborn case of KP may require a skin care professional to try out a mÃ©lange of different topicals before hitting on the right combination. Over the counter, these might include a 2% salicylic acid wash, 12% ammonium lactate lotion, or a concentration of alpha hydroxy acids. By prescription, we have azelaic acid, tretinoin, 6% salicylic acid, and urea 40%.
And last but not least, on exposed areas by day youâ€™re going to want to make sure you use a sunscreen that is specifically non-occlusive or non-comedogenic (that is, non pore-plugging).
Right now, mechanical exfoliation plus topical exfoliation can work wonders on KP. While we may not be able to eliminate keratosis pilaris completely just yet, we can certainly accomplish a lot. But stay tuned because new discoveries are happening all the time and we wonâ€™t stop until your skin looks perfectly clear.
KP happens but it doesnâ€™t have to show on your skin.
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