By Kathryn Leverette, CMES

What does KP look like? This annoying skin disorder, called keratosis pilaris (KP), is characterized by thousands of hard, non-inflammatory keratin plugs that cover the hair follicles, making the skin rough and pebbled, in appearance and to the touch. And, it worsens dramatically if picked and scratched. Skin tampering invites secondary infection, enlargement of the bumps, delayed healing and unsightly discoloration. These dark, discolored sores mimic burned-out acne and can cause permanent scarring.

Does KP look different on People of Color?   Yes. On many black, Hispanic, Asian and dark or olive-skinned people, KP resembles thousands of tiny blackheads and dark blemishes blanketing the skin.

What parts of the body are affected?  The backs of the arms, the shoulders, the front and sides of the upper legs, the calves, the buttocks and occasionally on the cheeks of small children, though its not limited to those areas.

What causes KP?   Though KP has been blamed on everything from shaving to tight jeans to dry skin, keratosis pilaris is a chronic, genetic condition caused by hyperkeratosis, the build-up of dead skin cells that cover the follicle opening. 
           
Is there a cure for KP?  No. Though KP can be controlled, the can bumps return shortly after abandoning treatment. While there is no lasting "cure”, consistent home management can keep those bumpy symptoms in check, lessening the risk of hyperpigmentation.

What can I do to treat my KP?  Gentle, twice daily use of natural bristle body brush with an alpha hydroxy acid, sulfur or benzoyl acne soap or cleanser can sometimes solve the problem. Keratolytic topicals like sulfur/resorcinol lotion, benzoyl peroxide (BPO), glycolic or lactic acid gel or lotion, potent Retin-A® can all be highly effective with regular use. Since 1989 most health insurance carriers won’t cover Retin-A® prescriptions for adult patients over 26 years of age; the large amount of Retin-A® needed to keep keratosis pilaris under long-term control make its use financially prohibitive.

My KP seems to improve when I get a lot of sun. Why?  Sun exposure causes mild burning and subsequent peeling (similar to BPO, Retin-A®, AHA, BHA, etc.) that temporarily exfoliates KP bumps. But, the sun also darkens bumps on People of Color and causes premature aging, the destruction of skin texture, unsightly sun spots (keratoses), sagging of the skin and skin cancer.

How do I use these exfoliating products?  Since keratosis pilaris most frequently affects the non-sensitive areas of the upper arms, thighs and buttocks, topical exfoliating products may be used daily in the absence of skin irritation. Product potency and the daily application schedule should be evaluated and varied according to individual skin sensitivity of those areas and other affected body parts.

What if my KP is red in appearance?  Some light-skinned KP sufferers get a non-inflamed form of “red” KP characterized by thousands of tiny rough red bumps. Others have an inflamed KP condition that resembles active acne and larger lesions, often caused by picking. Cleansers and topicals containing benzoyl peroxide (BPO) and/or sulfur, which are both anti-bacterial exfoliants, work well on all red and/or inflamed KP. Keep in mind that it bleaches fabric and must not be worn if one expects to perspire or be exposed to the sun. It works best when worn on the affected area at bedtime, followed by clean white T-shirts and/or pajamas.

What if the KP is bumpy but not inflamed?  Alpha hydroxy acid (glycolic or lactic) lotions or gels (10% to 15%) can be applied sparingly once or twice day, and rubbed thoroughly into the skin until all traces have been absorbed. Unlike benzoyl peroxide, alpha hydroxy acid (AHA) won’t discolor fabric. For non-inflammatory and post-inflammatory cases, alpha hydroxy acid lotions and gels can be applied sparingly in the absence of irritation.

What if my KP bumps are much darker than my skin tone?  Sometimes, KP looks like a sprinkling of blackheads, especially on People of Color. Formulations containing alpha hydroxy acid (glycolic or lactic) formulated with lighteners and brighteners along with bleaching soaps can work wonders on KP that is a much darker brown than the surrounding skin. Hydroquinone (HQ) must be allergy patch-tested for three days prior to use unless you have used skin lighteners containing HQ without adverse reactions in the past. Body exfoliants containing AHA and formulated with hydroquinone and skin brighteners are designed specifically for use on hyperpigmented skin if direct sun is avoided and full-spectrum sunscreen is used religiously.

How do skin lighteners fade the spots caused by KP?  These products work three ways. First, alpha hydroxy acid softens and exfoliates the buildup of keratin (dead skin cells) that buries the hair follicle. Next, it acts as a “vehicle” to carry skin lighteners and brighteners deeper into the follicles. Last, skin lighteners help inhibit the over-production of dark melanin coloration in the basal layer of the epidermis, but need a vehicle with a small particle size to penetrate deep enough to be effective.  Lighteners and brighteners include hydroquinone, kojic acid, mandelic acid, arbutin, bearberry extract, mulberry extract, azelaic acid, licorice root extract, l-ascorbic acid, vitamin K, lemon and lime extract, and others. These ingredients perform best when formulated with a “penetrant” (like AHAs and retinoids) that allows these melanin-suppressors to penetrate the follicle.

Can I go into the sun after the KP clears up and my spots fade?  If your skin is exposed to any direct sun at all, it is important to apply full-spectrum sunscreen hourly. Try to make every effort to avoid the sun whenever possible. This is especially important if any discoloration is present, or if your skin blemishes have a tendency to over-darken. Previously hyperpigmented skin can darken faster than the surrounding skin, even after the spots have faded and the KP is under control. Keep in mind that a variety of health problems and medications can make your skin extremely sun sensitive and total sun avoidance is advisable.

What are the side effects of these treatment products?  The side effects of the treatment for keratosis pilaris can include temporary dryness, mild peeling and itching and the presence of superficial darker patches of dead skin cells. These symptoms subside as the skin gets used to exfoliating lotions and gels, and if they are used exactly as directed. Overuse will worsen or prolong these symptoms.

Can scrubbing help my KP?  Gentle exfoliation in the absence of irritation can help keep the KP-affected skin smooth. Excessive pressure, rough scrubbing and picking are taboo. They increase the risk of uncomfortable side effects, irritation, sun sensitivity and dark discoloration.

Are any treatments available to boost my efforts?  Professional glycolic and lactic acid peels, the absence of irritation, can be useful in boosting stubborn cases.

Can I stop treatment after I clear up?  No. Keratosis pilaris is a chronic genetic condition with no permanent cure. Home maintenance must be continued permanently to prevent the bumpy or symptoms from recurring.

© 2003 Kathryn Leverette, Solutions Center, Kathryn Leverette, Inc.