Treating Keratosis Pilaris
by Claudia Truffello
Keratosis pilaris is a common genetic follicular disorder manifested by the presence of coarse bumps on the skin and hence colloquially referred to as "chicken skin" or "goose bumps".
Prescription treatment options to alleviate keratosis pilaris are topical corticosteroids, urea, retinoids, and topical immunomodulators. Topical use corticosteroids, like triamcinolone 1% or desonide 0.05%, can be useful if over-the-counter solutions are found to be ineffective against inflammation. Prescription topical agents should be applied two to four times a day as a thin layer that is spread onto the affected area. Just as with milder concentrations of hydrocortisone, caution should be used with the prescription medicines. Additionally, prescription-strength hydrocortisone can inhibit collagen formation and thereby lead to skin striate.
Concentrations of urea over 30% can be used to alleviate rough surfaces of the dermis. However, the urea proportion contained in the legend solutions is usually sensitizing and not a popular choice.
Topical retinoids applied in the treatment of keratosis pilaris include adapalene, tazarotene, and tretinoin. Their method of action can be to increase turnover of follicular epithelial cells. These agents must be applied as a thin layer to dry skin, at bedtime, to no more than 20% of the skin's surface. The adverse effects of redness, strong dryness, and peeling are in some instances rate-limiting issues for most patients. However, some topical retinoids are available in reduced concentrations or in an emollient product base when compared to the original solutions.
Contact of the retinoid with the eyes and mouth must be avoided. Also avoid exposure to ultraviolet light. Just like the AHAs, topical retinoids should be initially applied every other day with a small-concentration product and increased to higher concentrations as tolerated. Burning and pruritus are usually seen in the first four weeks and usually lessen with time. Topical retinoids are teratogenic and must not be used by women of childbearing age. One product's package insert recommends female patients should start therapy during a normal menstrual period. Prescribing data also states that children under the age of 12 must not use topical retinoids.
Topical immunomodulators, pimecrolimus, and tacrolimus can also be of benefit if other treatments have been ineffective. However, a public health advisory has been issued by the FDA about a potential danger of skin cancer with the use of topical immunomodulators for the therapy of eczema.
These solutions must be applied twice daily to the affected areas. If a moisturizer is also being applied, the patient must be instructed to use the moisturizer after pimecrolimus. Patients must be cautioned to avoid exaggerated exposure to sunlight.
Patients can initially complain of a sensation of warmth or burning and skin irritation, especially during the first week of use. Most of these responses will usually subside five to seven days after therapy. An advantage of the topical immunomodulators is that their use is indicated for children 2 years of age and older.
Another advantage is that these agents do not impede collagen production and will not cause skin thinning. Occlusive dressings must be avoided with these agents. These agents must not be used in people with a compromised defensive system or during pregnancy since there are no adequate and well-controlled researches of topically applied agents in pregnancy.
A new skin care product offers the opportunity to eliminate scars, imperfections and several skin conditions thanks to natural components that regenerate and heal your skin.
Published January 10th, 2008
Filed in Beauty, Health, Women
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