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KP: Rough and Bumpy Skin (also known as strawberry leg and chicken skin)
Guide to the Management of Keratosis Pilaris
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 can mimic burned-out acne and cause large blemishes and 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. Yet, KP can also be tan, flesh-toned or even red in color.
What parts of the body are affected? Affected areas can include the backs of the arms, forearms below the elbow, shoulders, hips, buttocks, back and sides of the upper legs, calves, and cheeks (especially younger people), 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 hardened dead skin cells that cover the follicle opening. Hormones can also be a factor.
Is there a cure for KP? No. Though KP can be controlled, the can bumps often return shortly after one abandons daily 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 KP on the body? Gentle, twice daily use of a nylon net sponge with an alpha hydroxy acid, sulfur or benzoyl peroxide soap or cleanser can sometimes solve mild KP problems. Keratolytic topicals like sulfur/resorcinol , benzoyl peroxide (BPO), glycolic or lactic acid, urea and potent retinoids can all be highly effective with regular use. Most health insurance carriers won’t cover retinoid prescriptions for adults over 26 years of age and the large amount needed to keep KP in check make retinoids 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 and camouflages 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. When the tan fades, thousands of dark spots remain in its wake.
How do I use 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 once or twice a day 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. Some have an inflamed KP condition that resembles active acne and the larger lesions are 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, especially on the body. They work best when worn on the affected area at bedtime. Other exfoliating lotions can be worn duriung the day. Keep in mind that BPO bleaches fabric and must not be worn if one expects to perspire or be exposed to the sun and can migrate through other lotions into sensitive areas.
What if my KP is bumpy, but not inflamed? Alpha hydroxy acid (glycolic, mandelic or lactic), salicylic acid, acetyl salicylate and/or potent urea lotions or gels can be applied sparingly once or twice daily in the absence of irritation, and massaged thoroughly into the skin until all traces have been absorbed. Unlike benzoyl peroxide, these active ingredients won’t discolor fabric or migrate into sensitive areas.
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. Exfoliating “bleach” soaps and products formulated with alpha hydroxy acid (glycolic, mandelic or lactic) and skin brighteners can work wonders on KP that is darker than the surrounding skin. Body exfoliants containing AHA and skin brighteners (alpha-arbutin, kojic acid dipalmitate, mandelic acid, azelaic acid and others) are designed specifically for use on hyperpigmented skin in the absence of irritation, 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 acids exfoliate the buildup of keratin (dead skin cells) that buries the hair follicle. Next, they can also act as a “vehicle” to carry skin brighteners deeper into the follicles. Last, the brightening ingredients help inhibit the over-production of dark melanin coloration in the basal layer of the epidermis. Brighteners include alpha-arbutin, kojic acid dipalmitate, mandelic acid, bearberry extract (beta-arbutin), mulberry extract, azelaic acid, licorice root extract, l-ascorbic acid, vitamin K, lemon and lime extract and others. Brightening melanin-suppreesors perform best when formulated with a “penetrant” (like an AHA or retinoid) that acts as a “vehicle” to carry them deeper into 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? Performed regularly and in the absence of irritation, gentle exfoliation can help keep KP-affected skin smooth. To reduce the the risk of uncomfortable side effects like irritation, temporary discoloration and sun sensitivity, don’t overuse homecare products, apply excessive pressure, scrub too hard, rub with a towel, pick at the bumps, or wear clothing or footwear, especially boots and tight jeans, that bind or rub the skin.
Are any treatments available to boost my efforts? Professional light skin peels, used only in the absence of irritation, can help address stubborn KP.
Can I stop treatment after I clear up? No. Keratosis pilaris is a chronic genetic condition with no permanent cure. Home maintenance must be ongoing and diligent to prevent bumpy symptoms from recurring.
Note: Individual results may vary and require compliance to corrective home care products, diligent sun protection, professional treatments, and important lifestyle changes, all of which must be monitored and maintained on a longterm basis.
©2011-2016 Kathryn Khadija Leverette. Reprinted with permission.
The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.