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Keratosis Pilaris (KP)
(November
1999)
Keratosis
Pilaris (KP)
is a skin condition that most commonly shows up on the skin as rough bumps
around hair follicles on the back and outer side of the upper arms. KP is an
extremely common condition that can be cosmetically troubling but is
generally not harmful in a medical sense.
It is estimated to
affect roughly half of the world’s over-all populace. The inheritance pattern
of KP is dominant. This means that only one copy of the KP gene is required
to result in a person developing this condition. The practical implications
of this are that if one parent has KP, the chance of the couple’s child
having KP is over 50%. If both parents have the condition, the odds are even
higher.
KP can present on any
area of the body with hair follicles and at any age. The most common sites of
involvement are on the backs of the arms, but it often involves the front of
the thighs, and occasionally the face, particularly in children. The bumps of
KP on the faces of children are often confused with acne. Adolescence is when
KP is typically most developed and noticeable. It slowly improves thereafter.
In some people, KP is very widespread involving the body, arms, legs and
face. Such widespread cases are particularly difficult to treat.
The bumps of KP
result from the way in which scales are shed from the outer skin around KP
affected hair follicles. In these follicles, the outer skin scales are
excessively adherent and do not shed easily. This results in a buildup of a
scaly bump around the follicle. The scale buildup often entraps the hair
within the follicle. The trapped hair gets bunched up and may lead to a red
irritated bump that may even fill with pus. These pus filled red bumps are
often confused with bacterial folliculitis or acne.
Treatment of KP is
sometimes difficult. There is no universally effective treatment. Sunlight
does help this condition, but sunlight in general is damaging to the skin
over-all and is not recommended treatment for KP. Moisturizing creams with
lactic acid such as Amlactin or LacHydrin may be helpful. Urea containing
products such as Ultramide
25 and high potency glycolic acid
products are also potentially beneficial. These medicated lotions
generally need to be applied at least twice daily and work by softening the
adherent skin scales around the follicle enabling them to be shed more
easily. Some people find that the use of a Buff-Puff, either to apply the
medicated creams and/or to abrade the skin during washing, may increase the
benefits of these products. Other people find that this abrasion simply
causes extra irritation and aggravates the KP. Vitamin A derivatives and
analogs such as Retin A and Differin may also be helpful in some cases. The
benefits of vitamin A derivatives in general, and Retin A in particular, are
often limited by irritation.
Keratosis pilaris is
usually easily diagnosed. Nevertheless, misdiagnosis may occur when the
physician is not very experienced in the evaluation of this condition. KP
does not necessarily require treatment. When treatment is desired, obtaining
good results is challenging, even with guidance of an experienced
dermatologist. Since KP is genetic, the skin returns to its pretreatment
character if treatment is discontinued. The treatment of KP is best
individualize and may require trails of several different products and
application methods for optimal results. The good news is that virtually
every case of KP can be improved if the patient is motivated and willing to
apply ongoing treatment.
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