KERATOSIS PILARIS: DEFINITION, HYPERKERATOSIS PILARIS TREATMENT, KERATOSIS SKIN

Keratosis pilaris: definition

Keratosis pilaris (chicken skin disease) is quite a common skin condition affecting lots of people of any age. Actually, its a benign condition revealing in form of multiple tiny rough red bumps, generally around hair follicles located on the upper arms, thighs, and sometimes cheeks. Keratosis pilaris makes skin look like socalled chicken skin, goose bumps, or gooseflesh. Most people suffering from keratosis pilaris dont even know that their skin condition has a special medical term and is treatable. In short words, keratosis pilaris is just cosmetically displeasing, but in fact is absolutely harmless. The condition often presents in otherwise healthy people.

Appearance of keratosis pilaris

Usually, keratosis pilaris reveals as a scattered, patchy rash made of tiny red bumps. There are dozens of tiny slightly rough bumps scattered in an affected area, which may have a fine, sandpaper-like texture. The bumps may be tan or slightly red, or they can have an accompanying light-red halo indicating inflammation. Small, coiled hair can be seen trapped beneath the rough bump. Meanwhile, acne whiteheads, also known as milia, may also present in the same areas as keratosis pilaris. People generally complain of a rough texture and a strange cosmetic appearance of the skin. If the condition reveals in the cheeks, they may appear pink, flushed, and be studded with tiny bumps.

Conditions similar to keratosis pilaris

There are some other medical conditions that can resemble keratosis pilaris, including acne, eczema, milia, atopic dermatitis, folliculitis, facial rosacea, or xerosis. Besides, the condition may also resemble some rare skin disorders, such as lichen pityriasis rubra pilaris, spinulosus, phrynoderma, eruptive vellus hair cysts, Kyrle disease, perforating folliculitis, and many more. Meanwhile, in India and other parts of the world, there is a specific skin disorder callederythromelanosis follicularis faciei et colli, which is believed to have a genetic relationship to keratosis pilaris. That disorder is also characterized by redness of the face and neck, blocked hair follicles, and the triad of darker skin color.

Cause of keratosis pilaris

Actually, the exact cause of the disorder is unknown, but most doctors agree that theres a problem with overproduction of the keratin in the skin, which is known as hyperkeratinization. Keratosis pilaris is believed to be partly genetic in origin, because around 50%-70% of people suffering from keratosis pilaris have a known genetic predisposition and many affected relatives. Lots of the patients have a strong family history

of keratosis pilaris or chicken skin. The true cause may be connected with hypersensitivity reactions and general dryness of the skin. Keratosis pilaris is also closely connected with allergies (including seasonal), asthma, ichthyosis vulgaris, rhinitis, eczema, and atopic dermatitis. So, the bumps caused by keratosis pilaris are thought to arise from the excessive accumulation of keratin, which is tiny dry skin particles, at the opening of separate hair follicles. If you look at the affected skin under the microscope, you will see hyperkeratosis, mild thickening, and plugging of the hair follicle. In addition, the upper skin layers may show some dilation of the tiny superficial blood vessels, which gives the skin a red or flushed look.

People affected by keratosis pilaris

Actually, anyone can get keratosis pilaris. Though it is more likely to reveal in children and adolescents, lots of adults are also affected. According to some researches, keratosis pilaris affects around 50%-80% of adolescents and nearly 40% of adults. Meanwhile, women are more often affected than men. The condition usually appears at the age of ten and can especially worsen during puberty. Nevertheless, keratosis pilaris may appear at any age. Most of patients turn out to have relatives affected with the same disorder, usually twins. Besides, the condition is frequently noticed in atopic dermatitis patients and people with extremely dry skin.

Prognosis of people with keratosis pilaris

In general, keratosis pilaris is a chronic skin condition which periodically becomes better or worse. Its a benign, non-contagious, self-limited skin disorder, which is usually mild and tends to improve with age. Lots of people notice improvement of the symptoms in summer. Meanwhile, more widespread, atypical cases of keratosis pilaris may be cosmetically distressing.

Chances to outgrow keratosis pilaris

Keratosis pilaris frequently improves with age, and may even spontaneously disappear after puberty. Nevertheless, it usually becomes chronic, showing periodic improvements and exacerbations. Lots of adults are still affected into their 40s and 50s.

Parts of body affected by keratosis pilaris

It can be possible to have keratosis pilaris all over the body, but this is extremely rare. Usually keratosis pilaris is most characteristically seen in the back of the upper arms. Among other common parts of the body there are the thighs and sometimes the face. The condition doesnt reveal in the mouth, eyes, palms, or soles.

Methods of diagnosis of keratosis pilaris

It is very easy to diagnose the keratosis pilaris disorder, as it is done on a typical skin look in specific areas, such as the upper arms. Meanwhile, a family history of keratosis pilaris can also be helpful, because

theres a very strong genetic component to the disorder. Finally, the diagnosis can be confirmed by the clinical exam of the physician.

Laboratory tests aid in the diagnosis of keratosis pilaris

There werent any specific lab tests to diagnose keratosis pilaris. Such imaging studies as X-rays and CT scans cant be useful for this disorder, but skin biopsy, which is surgically taking a tiny piece of skin, may appear useful in some atypical or widespread cases.

Look of keratosis pilaris under the microscope

Pathology or histopathology is a microscopic examination of the piece of the skin by a pathologist or dermatopathologist under high magnification. So, histopathology of keratosis pilaris can show thickening of the outer layer of skin, which is called mild hyperkeratosis of the epidermis, as well as plugging of some hair follicles, and increase in the special granular cells of the epidermis, known as hypergranulosis. In addition, the upper layer of the skin located below the epidermis, also known as dermis, may show microscopic inflammation, which is called mild superficial perivascular lymphocytic inflammatory changes.

Contagiousness of keratosis pilaris

Keratosis pilaris isnt contagious, since it isnt an infection and isnt caused by a virus, fungus, or bacterium. So, patients cant give it to others through skin contact, and, vise versa, cant catch it from the others. The fact is that some people are just more prone to being affected by keratosis pilaris due to skin type and genetics.

Complications of keratosis pilaris

Generally, there are no complications, because it is primarily a cosmetic skin disorder. Still, hyperpigmentation or temporary skin discoloration, also known as postinflammatory hypopigmentation, which is a bit lighter than the common skin color, may happen after a temporary flare or after the inflamed red bumps have become better. However, permanent scarring rarely occurs, caused by deep picking and overly aggressive treatments, or by some other inflammation.

Cure for keratosis pilaris

No cure is available, so dont look for a miracle pill or universally effective treatment for the disorder. In fact, it can clear completely by itself, without any treatment.

Benefit of diet for keratosis pilaris

In general, it is believed that diet doesnt affect keratosis pilaris. Although vitamin A deficiency is able to cause some symptoms that are similar to keratosis pilaris, it isnt a proved cause of the disorder.

Methods of treatment of keratosis pilaris

There are a lot of treatment options and skin-care regimes currently available that can help control the symptoms of keratosis pilaris. A majority of the affected people have great temporary improvement if they follow a common skin-care program of moisturizing. However, as any treatment, this one needs to be continuous. As theres no universally effective treatment available for keratosis pilaris, theres a huge list of potential creams. Meanwhile, when experimenting with them, its important to remember that as with any condition, no treatment can be uniformly effective in all patients, and complete recovery may not be possible. Sometimes, keratosis pilaris may improve or completely clear without any treatment at all, just by itself. People affected by the disorder are recommended to try general measures designed to prevent excessive skin dryness, like using mild soapless cleansers. Permanent skin moisturizing is the main advice for almost any case. Those looking for ways to achieve best results are recommended to combine therapy of topical products with physical treatments, just as gentle exfoliation and chemical peels. Actually, the mild cases of keratosis pilaris may be improved with regular over-the-counter moisturizers like Cetaphil. For those having more difficult cases of the disorder, there are other treatments, like lactic-acid lotions, retinoic-acid products, alpha-hydroxy-acid lotions, salicylic acid, urea cream, and topical steroid creams. Besides, there are some specially mixed combinations in one prescription cream, which contains many ingredients. The affected skin is recommended to be washed one or two times a day using a gentle wash, such as Dove or Cetaphil. As for the acne-prone skin, it may benefit from using more therapeutic washes, such as Glysal, Proactiv, benzoyl peroxide, and salicylic acid. Lotions are advised to be gently massaged into skin 2 or 3 times a day, while irritated skin can only be treated with bland moisturizers. Sometimes physicians may prescribe a 7- to 10-day course of a topical steroid cream to be used one or two times a day for inflamed red areas of skin. Weekly dosing of topical retinoids can also be very effective and tolerated, though they only get partial response. After the patient has tried initial clearing using stronger medications, he or she must switch to milder maintenance regimens. Those people who suffer from persistent skin discoloration may try fading creams, such as prescriptiongrade kojic acid, to solve the problem. In addition, a compounding pharmacist can also prepare a special compounded cream containing higher concentrations of hydroquinone. However, therere lots of treatments that have been used in keratosis pilaris without consistent results. But since theres no miraculous cure for the condition, its very important to proceed with mild caution. A list of available in-office physician treatments can be useful for someone as adjunctive treatment. The list includes different chemical peels, blue light, dermabrasion, laser, microdermabrasion, photofacials, ad

many more. In general, in-office treatments combined with a physician-directed at-home skin-care is the best. Patients suffering from severe cases of keratosis pilaris can be treated with isotretinoin pills for a few months. Its a very potent oral medication, which is usually reserved for severe cases of acne, so its use in keratosis pilaris is considered not approved and not routine. Meanwhile, photodynamic therapy has been occasionally reported as effective, though it requires further trials. Then, microdermabrasion represents quite a safe in-office procedure involving minimum of invasion, whereby the affected areas of skin are gently exfoliated. With help of vacuum-assisted suction, these parts of the skin are rubbed with some abrasive particle like fine, small diamond tips, or powdery aluminum crystals. The procedure helps remove the excess keratin and outer layers of the skin in a balanced, controlled manner. However, just as other treatments for keratosis pilaris, this one only shows small group observations and occasional reports. An alternative to in-office procedure is at-home exfoliation using a loofah sponge or Buf-Puf. Keratosis pilaris may also be improved by using topical immunomodulators, which are medications dampening or altering the immune system of the patient. Despite the fact that immunomodulators are officially approved for treating atopic dermatitis and eczema, they are not approved for keratosis pilaris. So, they can be used in some situations that are more resistant, or when considerable skin redness appears. Similarly, newer prescription creams like Atopiclair and MimyX may also have an off-label role in treating the symptoms of keratosis pilaris, as they are thus far approved for atopic dermatitis only. Calcipotriol ointment, in its turn, has been used effectively in different skin disorders, like ichthyosis vulgaris and psoriasis, but never shown a therapeutic effect for keratosis pilaris during clinical trials. Finally, as keratosis pilaris is most frequently a chronic disorder which requires a long-term treatment, repeated or long-term use is required for achieving optimum results.

Below is a sample treatment for a person suffering from mild to moderate keratosis pilaris:

every month get a microdermabrasion and glycolic treatment with your physician; - every other night apply Tazorac or Retin-A cream; - every morning apply Salex or AmLactin lotion; - wash the affected area with Glysal cleanser daily; - pat skin dry.

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