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Hey chicken skin. I have what? Keratosis Pilaris.

on March 28, 2014

Most likely you, or someone you know has Keratosis Pilaris (KP). In fact, it is estimated that 50% of all adults have KP, while the percentage skyrockets for children and teens (80%). Here are a few photos of my own patients that I have taken over the years. All of these are KP – none of them are acne.

kp3 KP – right side of face (female)

kp1

 

 

 

 

 

KP – elbow (male)

 

kp2 KP, dark skin tone, back of arm (male)

kp4 KP, back of arm (female)

 What is keratosis pilaris (KP)?  The bumps you see are excess protein (called keratin)—that have filled the hair follicle because the skin cannot properly shed the dead skin cells covering the follicle.  (This process also occurs in acne, which is why both conditions are so common in adolescence.)  The bumps can become inflamed, itchy, and irritated when dry or dehydrated. KP is identified by the accumulation of little bumps on your skin induced by the accretion of keratin inside the trapped hair follicles creating a plug. Often, when I use this explanation, clients will exclaim “but I don’t have hair on the back of my arms!” Yes, you do. It’s normally very fine and blonde or white – but if KP is present, the hair can’t break through the follicle (hence some of the problem). Before we begin with how to tame KP skin – understand that KP is a very common skin condition that is almost always problematic aesthetically, but poses no threat clinically and is not contagious. Often, KP does not require medical treatment, but it can be embarrassing – and is one of the most misdiagnosed conditions.   The most common sites for KP are the backs of the arms and upper thighs, however – I have seen adolescents with KP on their forehead and on their cheeks, and on a toddlers trunk. It can look like fleshy bumps, bumps that appear to be whiteheads that never surface, when exfoliated often what comes out of the skin is described as “little seeds”, or the bumps can be in red/purple patches that are dry and somewhat irritated. Keratosis pilaris is often misdiagnosed as a rash, dermatitis, acne, rosacea, or eczema. While most people with KP will not need to see a dermatologist for a medical treatment for KP, I think it is a good idea to have a professional diagnosis, especially when a bothersome skin condition does not respond to suggested home remedies or persists longer that two weeks. There are many offices that have products that come in kits for KP that can be pricey and often do not work. Before attempting over-priced harsh, “one size fits all” kits, let’s go over what to do – and , more importantly – what not to do. Here are some facts, tips and tricks to deal with KP:

  • Keratosis pilaris is hereditary (inherited as an autosomal dominant gene.) This is similar to the brown versus blue eye color phenomenon. All it takes is one single gene from either parent to find oneself with less than perfectly smooth skin. But not everyone can point a finger at who’s to blame since on average, only 40% of KP patients have a positive family history. Therefore, if no one in your family has ever had KP, my next question would be related to your diet. Not every case, but in many cases, I have found that if clients eliminate wheat and dairy from their diet, their KP will disappear. You do not have to be diagnosed as having Celiac disease in order to suffer with side-effects from these food choices. It’s worth a try, right? It also will most definitely make you feel better. You’re skin will glow!Even if you don’t have obvious digestive problems, if you suffer from skin conditions, allergies, weakened immune system, or even psychological imbalance – it is very likely linked to a digestive weakness and/or gut flora imbalance. This can be due to a chronically poor diet, a period of high stress, or even as little as a single course of antibiotics at some point in your life. “Healing your gut” is usually not a quick and easy process, but something that you cultivate over time. I know there are some of you reading this blog and the very second you see “eat better, stop eating junk food” the sound of the teacher talking on the Peanuts plays in your head (the trombony “whaa-whaa-whaa”). Well, it’s the truth. If you have to hear it – it might as well be from me. Anyone who knows my story, knows that I was hospitalized in 1996 for 42 days, and darn-near died as a result. I had gut issues (misdiagnosed, like, forever) and as a result of the exploratory surgical procedures – ended up with chronic pancreatitis complicated with pancreatic pseudocysts (those buggers can and will try to kill you!)  It wasn’t until many years later I discovered I was one of the 3 patients who survived the clinical study I didn’t know I was in. That’s right, 7 of my clinical study participants died. Let me tell you how horrible my skin looked, then!  I know many of my clients see me regularly because I am one of the few (perhaps the only?) skincare professional in the area who will not try to sell you a skincare product line that costs as much as your mortgage. Yes, I do use some products (when needed), but there are few. (See products on right side bar of this blog). In addition, I have been told, I am the only professional that will also let you know that I will not take your money under the guise of making you feel better about yourself if your skin would just clear up – when, you are a smoker with no intentions of quitting, someone who will never eat a balanced whole food diet, or who will never exercise. My laser is a laser. It targets chromophores in your skin. It is not a magic wand. It will not make you look better than you ever have. If someone is selling you that, run. Don’t walk. (see, you can get moving!). Will I work with you? Yes. Baby steps are okay. Sometimes it’s a mysterious puzzle, but with honesty and teamwork – it can be done.

oranges

  • While we’re on the subject of diet – eat vitamin-C rich foods every day. Yes, you could take a supplement, but it seems much more logical to me to eat several servings of Vitamin – C rich in season fruits each day.  In general, Vitamin C is essential for collagen formation, helps  maintain the integrity of skin tissue, and counteracts free radicals which produces inflammation throughout the body. Specifically with KP, adequate Vitamin C can reduce redness and inflammation and prevent common ingrown hairs. Let us eat oranges! For other ideas and easy to follow recipes (and for juice loving clients), visit Rachel Holder’s blog by clicking here. The recipe that I juice at least twice a week for great looking skin can be found on her blog here.

 

  • If you have KP, it is quite possible that you are not getting enough Vitamin A. Without adequate amounts of this fat-soluble vitamin, skin cells begin to excrete an excess of keratin creating dry, rough, scaly bumps. Many clients think that they can get vitamin A from eating foods like carrots, spinach, and sweet potatoes. Although it is quite helpful,  it’s equally important to understand that carotene in plant foods will probably not provide adequate daily vitamin A alone. It’s true that beta carotenes can be converted to vitamin A in your body once they make it into your blood, but beta carotenes are not always absorbed efficiently.  Taking true vitamin A as a supplement can also be dangerous since vitamin A toxicity is also a risk. That brings us to liver. The kind you eat. Liver is the best source of naturally occuring vitamin A. If you are in the minority of those who like liver – that is awesome! Eat it twice a week.This brings us to liver. Liver is far and away the best source of naturally occurring vitamin A. If you are in the small minority that like liver, great!  Eat it at least 1-2 times per week. If not, find some local farm ground beef/liver blend and sneak it into your spaghetti meat sauce or burgers. Baby steps.  If you simply can’t fathom the taste you can try cod liver oil capsules or dessicated liver capsules.
  • Coconut Oil. Just buy it. Then, use it. While It seems like the cycle of trying really hard to convince others that coconut oil is a wonder food (and it is) is cycling back around, some clients hear this and immediately say “I hate the way oil feels on my skin!” or “I have acne, there is no way I am adding OIL to my skin”. While I admit, it can feel a little strange to be carrying around a product that promotes itself as DELICIOUS IN COCONUT CAJUN SHRIMP recipes into the shower, and on an airplane – it works. Plain and simple. Personally, I do not like fragrance that makes me smell like food – coconut oil doesn’t smell overly coconut-ty, but it doesn’t smell bad either. Coconut oil is a solid at room temperature, but liquefies almost immediately with the warmth of your hands. It absorbs really fast, so for oily feeling haters – there will be minimal “EW EW EW GET IT OFF ME” feelings to deal with. Simply take a shower and immediately after wrapping your wet hair up, apply to your skin. Allowing your skin to air dry is best, but if you are in a time crunch, lightly pat dry with a clean towel and apply coconut oil. In minutes your skin will absorb the oil. It will not leave any residue or stain clothing. Although this is not a clinical treatment – there is REAL science to this. Coconut oil (unlike all other oils) can actually penetrate tiny hair shafts and deliver it’s protein rich goodness to your congested hair follicle. This alone creates a natural inside-out exfoliation process. You should see amazing results within one week of daily use. I have used this product for years. It’s cheap. It comes in enormous jars – and it works. Not only does it work, but in a pinch, I can eat it too? This is skin-care product perfection in my eyes.

 

  • Use a cool-mist humidifier in your bedroom each night. KP is a chronic dry skin problem and the extra hydration in the air from the humidifier will provide extra insurance that your skin needs. Less moisturizing product will be needed too.  Be sure to clean your humidifier daily to avoid the buildup of molds and bacteria.  It sounds like a lot of work, but your skin will thank you.
  • For teens and adults: schedule a glycolic peel with a professional. Let’s talk about this for a minute. There are many, MANY wonderful day spas in my town that do a fantastic job. They will pamper you until your heart is complete. What they can’t do is use clinical grade peels. Often, my clients will text and tell me where they are and want to know what service they can have. I not only welcome this – I love it! It would be a better choice to have a glyocolic peel if you have KP, but the percentage non-medical spas are allowed will not be high enough to treat KP. Again, not harming is the best choice when you can’t treat.  Next, there are many MANY med-spa’s or dermatology clinics that have sold out, or given in to “insert popular name skin care line here” and only sell those lines. Often, they are full of many chemicals, fillers and preservatives that are not good for all skin (or any skin) – and man, are they expensive! Personally, I use peels with one ingredient. Glycolic acid. If I want a compound, (for example – treating KP AND Acne) – I’ll call a professional. I am fortunate that I have excellent compounding Pharmacists here in my community at Reeves-Sain that will create individualized products as requested. (note: these are prescribed products that require a Physician’s request. All of my peels are cleared through my MD/Medical director). It is always a bonus if I have to pick up the compound because very close to the pharmacy is the (insert glory music) – homemade milkshake counter. Coffee milkshake from Reeves-Sain, yes, please!

 

  • Ages 15 and over: Often, if KP is resistant to treatment and there are no “seeds” inside the bumps, and you want a faster route to clear skin – laser hair removal works extremely well. Even if the hair isn’t visible, there is still keratin (or color) in the stem cell of the hair follicle. Laser targets this and most often with one treatment the signs of KP are largely reduced. Since our goal is not hair removal itself, a series of treatments is not necessary. KP is not “curable” therefore, flare-ups can be treated as needed.

 

  • If you have had KP for a very long time and the skin is greatly discolored (red/purple) where the bumps were – one treatment of            combined laser genesis and IPL will take the awful reminder away.  This pain-free laser treatment is fantastic for reducing the signs of lingering KP.

 

Have KP? What not to do:

  • Do not give in to the temptation of using your foaming body wash or harsh scrubs to sandblast the problem with loofahs.  It won’t do anything but make it worse. Any foaming scrub will dry out the skin. Drying out the skin is counter-productive for KP taming. If you simply can’t give them up, look for one that contains rounded beads instead of seeds or nut shells.  Jojoba beads will be your best choice if you like physical exfoliants.  (However, don’t be confused – these washes and scrubs are not treatments suggested for KP, they just won’t aggravate KP and make it worse.)

 

  • Do not use your acne medication on areas with KP: this build up of keratin appears very similar to acne, but it’s important to understand that they are not the same animal and must be tamed differently. Overproduction of sebum (oil) is what complicates the treatment of acne, and most of the products available are very drying.  Using acne treatments that include benzoyl peroxide or sulfur on KP skin that is aggravated by any sort of dehydration or dryness is just a bad idea.  Moisturizing acneic skin commonly causes issues, while it is the first step in treating keratosis pilaris. Efforts to treat KP at home are often futile and can bring about unwanted complications when incorrectly using the wrong products.

 

  • Avoid hot water and bar soaps, as these are drying to the skin. Perfumed body products can also cause trouble, so if you love them, try to only use them on special occasions. If you simply love the perfumed lotion you use, try diluting it with an unscented lotion (mix 50% your lotion to 50% unscented lotion). I like CeraVe. It is available at Target, Walgreen’s, Wal-Mart and online on Amazon. In my area, Walgreen’s often has a special on CeraVe products and this moisturizer is one of the products in my must have arsenal at all times. Because I work in the medical field, excessive hand-washing during the dry/cold months can cause chapped hands. This lotion is the one I have found works the best. It also plays well with others – so, if I have a liquid foundation or tinted sunscreen that is slightly too dark for my skin tone, I can add CeraVe to it for added moisture and to tone down the color.

Image

  • Avoid tight clothing.  This is especially important during sleep.  For the guys, if KP is a problem – try boxers versus briefs.

 

  • If you are a soaking bath lover, try adding powdered milk and a few drops of a non comedogenic oil (like safflower!) to your bath water instead of foaming bubble bath that will dry out your skin. (FINALLY, a good use for that awful powdered milk my Aunt used to buy).

In summary, although KP rarely requires medical treatment, I have found that many cases are often misdiagnosed as acne – especially in the teenage population. Often, teens or parents of teens will seek treatment due to embarrassment surrounding acne eruptions, and the fear of scarring. KP is most commonly misdiagnosed as body acne that will not respond to treatment.  In many cases, acne treatments that are designed to dry out the skin, make KP considerably worse. Sometimes KP also appears on the lower part of the forehead—near and in between the eyebrows.  When found on the face, it is often confused with acne because the bumps resemble whiteheads.  Many of my clients have complained that there are no products available for “their” acne accompanied by dry skin—only to find out that they had KP all along, not acne.  This is why I always recommend that you be on the lookout when “your acne” doesn’t act like typical acne.   Once you have a KP diagnosis – there you have it! Ditch the junk, heal your gut/metabolism, eat oranges and liver…so long chicken skin!


6 responses to “Hey chicken skin. I have what? Keratosis Pilaris.

  1. thank you for this post. I have KB on my arms since forever and recently I have been breaking out on my face but when I squeeze the “pustule” what comes out is a waxy substance that’s is hard and in it a hair follicle. I have use several acne treatments without success instead leading to hyper pigmentation and red, imflammed skin….can you tell me if coconut oil will clog my pores and how much should I apply? thanks!

    Like

  2. Minta Cain. says:

    Lori – you are, as always, awesome. What a great article! Thanks! xoxom

    Like

  3. Minta Caine says:

    How did that period get put in place of the e on the end of “Caine”?! Haha!

    Like

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