Problem: Keratosis Pilaris Keratosis pilaris, also known as follicular keratosis, lichen pilaris or chicken skin, is a common skin condition that causes rough patches and small, acne-like bumps on the arms, thighs, cheeks and/or buttocks. Keratosis pilaris bumps are usually white or red and generally do not hurt or itch.1 Although no clear study of what causes this skin condition has been defined, keratosis pilaris is often associated with dry skin conditions such as ichthyosis vulgaris, xerosis and atopic dermatitis.2 As an autosomal dominant gene, keratosis pilaris is hereditary, taking a single gene from either parent to inherit less than smooth skin. However, it is difficult to pinpoint which parent is responsible due to only 30 to 50 percent of keratosis pilaris patients having a positive family history. Moreover, 50 percent of the entire population is affected by keratosis pilaris, affecting 50 to 80 percent of children and four out of every 10 adults. The growth of horny tissue in an excessive manner on the skin is known as keratosis. The functional changes associated with keratosis pilaris are due to the human body producing an excess amount of keratin which surrounds and entraps hair follicles within pores. Mild erythema is oftentimes formed around the hair follicles, indicating an inflammatory response. In some cases, a small, coiled hair can be seen beneath the papule. Conclusively, it is believed that papules arise due to an excessive accumulation of keratin at the follicular opening. Eventually however, this buildup results in hyperkeratinization (the formation of hard plugs) which causes an abrasive goose-bump texture of the skin. Case Study: A 24 year old female is scheduled for a consultation and body therapy treatment. During her consultation, you find out that she is concerned about a few red, pustule bumps located on the back, outer section of her upper arm. In addition, she also expresses concern about some small bumps that are starting to form on her upper thighs. After reviewing her client intake form and asking a few additional questions, you find out that she just recently gave birth, does not have any known allergies, takes daily vitamins, and is not taking any prescription medication. When asked about her skin care routine, she acknowledges using a loofah daily and an exfoliating body scrub maybe once a week. As a skin care professional, what solution do you propose to treat this case study? Solutions: Lisamarie Jaconi, vice president of sales and education for Naturopathica “First, I would ask the client if she has seen a doctor regarding her condition. It is always advisable not to diagnose a client, but rather have them consult with their doctor on specific conditions. However, I would recommend that the client add a topical lactic acid exfoliation treatment to her regimen since she is already using a few manual exfoliation methods at home. I would also explain how lactic acid will help with her condition due to the fact that it mimics the properties of glycolic acid but is typically better suited for individuals with sensitive skin, especially those suffering from keratosis pilaris. The antibacterial and hydrating properties of lactic acid will also focus on softening the keratin deposits in the skin, helping to prevent dead cells from plugging hair follicles.” Kerry Benjamin, L.E., owner of Spa Benjamin “Treatment is all about exfoliation. The best option is a series of chemical peels, but I would first advise the client to confirm with her doctor if a chemical peel is safe while she is breastfeeding. In most cases, it is 100 percent safe; however, if a woman is uncomfortable with it, there are alternative microdermabrasion treatments that will help clear up keratosis pilaris. At home, I would recommend using an electric face brush with a body attachment – using it in conjunction with an exfoliating scrub twice a week. I would also advise applying vitamin A or glycolic acid on affected areas daily. She needs regular professional treatments to ensure that it doesn’t come back, as it will easily reappear without a consistent combination of professional and home care treatments.” Amanda Wisth, skin care specialist, aesthetics instructor and makeup artist “Inform your client that she is not the only person dealing with this skin condition. Forty to 50 percent of all Americans are affected by keratosis pilaris. Although this condition may be hereditary, certain internal (hormones, stress, et cetera) and external (climate, skin care, et cetera) factors can cause keratosis pilaris flare-ups. There are multiple ways that keratosis pilaris can be treated, although a proper home care regimen is the first step in doing so. Exfoliation, both physical and chemical, and moisturization are key in tackling this skin condition. Using a high-quality lactic acid-based moisturizer once or twice a day will aid in sloughing of the layers of keratin while hydrating the skin, helping to maintain a smoother look and feel. Gentle scrubs with jojoba micro-beads, a topical retinoid product, and/or a glycolic acid body wash can also help reduce the appearance and feel of those pesky bumps.” Anne C. Willis, L.E., C.M.E., founder of De La Terre Skincare® “Keratosis pilaris is an indication that there are internal weaknesses that cause heat to rise and become trapped under the skin’s surface. As this heat festers, it irritates and damages skin cells and pores. The best way to support the skin is through applying topical nutrition to strengthen the skin’s weakened state. In addition, skin therapies should calm the inflammation and disperse damaged tissue for filtration. This can be achieved through topical hydrotherapy compressions. The action of compressing the skin will create internal motion allowing for filtration. Avoid language such as, “treating the condition.” The client must get to the root of the problem. Even though they think they are living a healthy lifestyle, the skin is communicating a different story.” Bella Schneider, aesthetician, owner and founder of Bella Schneider Beauty and LaBelle Day Spas & Salons “Given that the client just gave birth, she is more prone to keratosis pilaris due to the hormonal changes. The key to treatment is exfoliation and hydration. Begin by offering the following professional treatment of the affected area every three weeks: facials using needle extraction of bumps, manual exfoliation, microdermabrasion and LED light therapy. An additional option is a glycolic, TCA or jessner peel on the affected area. For medical spas, suggested treatments include chemical peels, laser treatments, laser hair removal, and retinoids or steroid creams. Advise the following home care routine: a mild soapless body cleanser to minimize dryness and a loofah and body scrub to dissolve buildup and/or cosmetic grade acid such as lactic, glycolic or salicylic acid or exfoliation pads for daily use. End with a soothing yet hydrating product to be used profusely (two to three times daily) and a topical tinted SPF or BB cream for coverage and aesthetics.” References:1 http://www.mayoclinic.com/health/keratosis-pilaris/DS007692 Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis. Sep 2008; 82(3):177-80Want to read more? Subscribe to one of our monthly plans to continue reading this article.