Keratosis Pilaris consists of spiny little white bumps that surround a hair follicle sitting on top of a pink-red base. The most common place that KP presents is the upper, outer arms, thighs and the buttocks. The entire arms and legs and trunk (except for the chest) can be seen in severe cases. KP often presents in people who have a personal or family history of atopy (asthma, hay fever and eczema).
KP is a disorder of the keratinocyte (the cells that make up the top layer of the skin called the epidermis. For some reason, the mechanisms that allow for regular cycling and sloughing of the skin cells does not work correctly around the hair follicle. This induces a little inflammatory response around the hair follicle which then makes the base of the bump become red and inflamed. Most people have a very difficult time to not pick at these bumps as it is really kind of fun to pick at them and see a hair pop out from underneath the piled up white mound of dead skin.
Under the microscope, we see piles of keratin around the upper hair follicle with an inflammatory response which often leads to destruction of the hair follicles.
Treatment of Keratosis Pilaris: There is no known cure for Keratosis pilaris, but the most effective treatments should focus on the two main problems in s KP; the buildup of dead keratin and the inflammation. Common prescription medications include retinoids like tretinoin, but unfortunately, these do not work very well and are too irritating for the sensitive skin that comes with keratosis pilaris. Topical steroids are also prescribed but they only address the inflammation and do not address the hyperkeratotic build up of the dead skin cells.
A great combination treatment is found in TrueLipids® Ceramide+ Cream and TrueLipids® Eczema Experts 1% Hydrocortisone Barrier Cream. (Link to recommended regimen)
Keratolytic: Gluconolactone is keratolytic (helps to slough dead keratin) without the dangers of alpha-hydroxy and beta-hydroxy acids like glycolic, lactic, mandelic, malic, and salicylic acids. The dangers in these acids is the increase in sunburn cell formation—these are dead, mutated cells that are seen under the microscope after skin is treated with one of these acids and is then exposed to ultraviolet radiation (sunlight).
Anti-inflammatory: 18-B glycyrrhetinic acid is a natural, highly purified molecule from licorice root that has wonderful anti-inflammatory properties that may benefit KP. This is combined with niacinamide which has been shown to benefit the eczema-prone skin seen in those with KP.
If KP is especially red, it may be even more beneficial to add the TrueLipids® 1% Eczema Experts™ Barrier Cream two times a day for a few days until the redness is improved. Then switch back to the Ceramide+ Cream.
Skin Barrier Lipid Replacement: We know that the skin barrier lipids are deficient and abnormal in eczema prone skin and that people with KP often have eczema. The TrueLipids® blend of essential skin lipids has been shown to benefit eczema prone skin and may also help KP prone skin to develop more normally.
Emollient: Hypoallergenic emollients (moisturizers) are also an important part of the treatment of KP. The emollient system in the TrueLipids® products is Truly Hypoallergenic and was made specifically for KP prone skin.
What to Avoid
- Picking and scratching; Picking equals scarring! Don’t do it no matter how much fun it is. Instead of picking, just apply another layer of Ceramide+ cream. Interestingly; KP is seldom itchy. It is more of an issue of “there is an exciting little bump there and my fingers like to pick at bumps!” So, please avoid this tendency!
- Scrubbing with loofa sponges or the skin-cleaning rotating brush devices. These modalities can increase the amount of inflammation around the hair follicle which then leads to hyperpigmentation. Another added benefit of the TrueLipids® products is that the 18-B glycyrrhetinic acid is also one of the most effective skin brightening molecules in the world and may help prevent the pigmentation that is left after KP has been picked at.
Who Will Get Stretch Marks?
Stretch marks, also called striae distensae, are very common and are NOT only seen in pregnancy or obesity. In some cases, stretch marks are a normal part of maturation and are particularly common in teenage boys and girls between the ages of 13 and 17 when there is a particular “magical” combination of hormones in the body. Stretch marks can also be a part of health conditions associated with overproduction of glucocorticoids, as a result of the topical application of glucocorticoids (especially when applied to the folds of the skin, the inner thighs, armpits, under the breasts and on the neck) and in pregnancy.
In pregnancy, between 30 to 90% of people develop stretch marks. A few protective secrets have been uncovered; the older you are when you are pregnant for the first time, the less likely you are to get stretch marks. (Maia et. al., 2009) Atwal et al., showed that teenagers were at the highest risk of getting stretch marks. They also learned that gaining less weight and having lower birth weight babies seem to be protective—but don’t let this make you try to have a low birth weight baby because studies have also shown that lower birth weight babies have lower IQs. I would trade a higher IQ for stretch marks! Interestingly, I have four sisters and three of us got stretch marks and two of us didn’t. I had my first child at the age of 32—despite gaining upwards 35 pounds.
Topical Treatments Do Not Prevent Stretch Marks
The Holy Grail in stretch mark therapy is prevention. Unfortunately, millions of dollars have been spent in product development and in research studies only to show that there is NO real, solid evidence that any products actually prevent them. In 2012, Soltanipoor looked and numerous studies of various topical treatment and found none of them really did much to prevent stretch marks. In fact, one study even showed that treatment with olive oil prevented people from getting more severe stretch marks, but it made them get more smaller stretch marks than the control group. Glycolic acid and tretinoin cream also seemed to make one’s stretch marks less likely to improve,(Naien and Soghrati, 2012).
Treatments that work to treat Stretch Marks: Laser Therapy
Fractional resurfacing with Er:Yag or CO2 lasers have been shown to be very effective. With fractional resurfacing, the laser vaporized tiny little holes in the skin; kind of like aerating the lawn–only you are aerating your skin on a much smaller scale. This treatment has been shown to be very reliably effective and requires 3-6 treatments spaced 2-4 weeks apart. Each treatment takes about 4-5 days to heal and requires the use of a wound healing balm afterwards. I like to use TrueLipids® Relieve & Protect Ointment because it is the only ointment in the world with skin-healing lipids and anti-inflammatory properties—great things for helping the skin to heal very quickly with low downtime and less inflammation.
The Nd:Yag laser has also been shown to be effective in the treatment of “immature” stretch marks—these are stretch marks that are so new that they are still pink or purplish. The Nd:Yag laser produced excellent improvement of 55% of patients in one study done by Goldman et. al in 2008. It is debatable if this is a worthwhile use of one’s money though; immature pink or purple stretch marks will almost always fade to white with time.