Keratosis Pilaris (KP)

For those out there with Keratosis Pilaris - (KP simplex link-those common bumps seen on the back of the upper arms) care should be taken using their recommended treatments from that link on vasoactive facial skin) with facial blushing/flushing/possible rosacea symptomatology, the following article shows shared treatment modalities with rosacea. Also antidepressants (SAM-e, venlafaxaine, etc.) & antihypertensives (clonidine, moxonidine, atenolol, propranolol, nadolol) & if unresponsive ETS surgery also reported to help with neural-stress-anxiety flushing. Commercial eyelid scrubs (ex.'s Ciba Vision & OcuSoft) & artificial tears (ex. TheraTears) & at times oral antibiotics (Ex. tetracycline) or if severe more likely topical immunomodulators may also help with any dry eye syndrome & skin inflammation. Substance P may also be involved.

http://www.keratosispilaris.org/ will soon GO-LIVE! - I will contact the owner for cooperation. When KP affects the highly vascularized, innervated face it can cause inflammation, redness, lowered flush threshold & soreness-pain, skin roughness even some scarring in certain cases.

Lasers/IPL isotretinoin (Accutane-Roaccutane) Genetics Stress Effects-Neuropathies

New: Lessons from chronic pain & neurovascularplasticity here

New : Candela Q & A email interview on Pulse Dye Lasers & their new Vbeam here

New : http://www.aad.org/DermSearch - Find a dermatologist by State, City, Area Code, Zip Code, Country

New : http://groups.yahoo.com/group/keratosispilaris - New support group set up at the request of visitors. I will only have time to participate there about once a month but will continue to share research.

It may be easier to join & manage yahoo group participation with a yahoo email address. This can be set up at http://my.yahoo.com . Click Sign In & Sign up now if you don't already have a yahoo email address. To manage all their yahoo group participation many also find http://groups.yahoo.com useful.

I should warn potential participants that if they find participation aggravates their symptoms such as facial flushing & inflammation then that stress response is a trigger that can be minimized with a more balanced, less tunnel vision focus of their problems. While I encourage people to become educated on their condition & treatment options they should not let it consume too much of their time. Try to keep posts productive and well balanced.

Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser.

Clark SM, Mills CM, Lanigan SW.

Department of Dermatology, University Hospital of Wales, Cardiff, Wales, UK.

BACKGROUND: Few therapies are currently available to treat keratosis pilaris atrophicans (KPA), a spectrum of disorders which includes ulerythema ophryogenes and atrophoderma vermiculata. OBJECTIVE: To evaluate the response of KPA to treatment with the pulsed dye laser (PDL) with regard to improvements in erythema and skin roughness, treatment tolerability, and side effects. METHODS: Treatment of all facial areas involved with KPA with the PDL at 585 nm was evaluated in 12 patients. Prior to and after each treatment skin erythema was estimated using an erythema meter, and skin roughness was analysed using micrometer evaluation of a skin surface biopsy taken from the same mapped area and analysed by computer to calculate the roughness profile. RESULTS: Patients received 2 to 8 treatments with the PDL with energies ranging from 6.0 to 7.5 J/cm2. Clinical improvement was noted in all patients with significant reduction in erythema scores. Pre-treatment scores ranged from 4 to 13 (mean 8.3) and post-treatment 0 to 8 (mean 3.1) (P < 0.05). Improvements in skin roughness were clinically apparent in all but two patients, but these were not significant on evaluation of skin surface biopsies. Treatment was generally well tolerated, and side effects other than local pain during treatment were very few. CONCLUSION: PDL treatment appears to be a safe and effective treatment for the erythema associated with KPA but does not give significant improvement in associated skin roughness.
(READ ARTICLE WITH BEFORE/AFTER PHOTOS HERE)
PMID: 11360333 [PubMed - indexed for MEDLINE]

- The new Vbeam Pulse Dye Laser may effectively treat KP without bruising like with rosacea: Read my Candela Interview HERE

Treatment of facial vascular lesions with intense pulsed light.

Angermeier MC.

Department of Dermatology, Brown University, Providence, Rhode Island, USA.

BACKGROUND: Various lasers, particularly the flashlamp-pulsed dye laser, have been proven to be effective in the treatment of facial vascular lesions. Nevertheless, the post-treatment side effects, such as pronounced purpura and changes in pigmentation, have been a matter of concern to patients. OBJECTIVE: To test the efficacy of an alternative treatment option that uses intense pulsed light to provide patients with a more tolerable post-treatment outcome. METHODS: A total of 200 patients were treated with an intense pulsed light source (PhotoDerm VL) using various treatment parameters. The patients were treated for facial veins (primarily telangiectasia), facial hemangiomas, rosacea and port wine stains. RESULTS: Of the 188 patients who returned for follow-up after 2 months, 174 achieved 75% to 100% clearance in one to four treatment sessions. The post-treatment side effects were minimal and well tolerated by the patients. There were no instances of scarring or other permanent side effects. CONCLUSION: The PhotoDerm VL provides a highly effective and safe alternative to the laser for treatment of facial vascular lesions. The device may achieve improved results for lesions that are resistant to laser therapy. The rate and degree of cosmetic side effects are considerably less than with laser treatment.

PMID: 11357295 [PubMed - indexed for MEDLINE]
: An intense light source. The photoderm VL-flashlamp as a new treatment possibility for vascular skin lesions.
Dermatol Surg. 1998 Jul;24(7):743-8.
PMID: 9693668 [PubMed - indexed for MEDLINE]

Also:

Chui CT, Berger TG, Price VH, Zachary CB.

Recalcitrant scarring follicular disorders treated by laser-assisted hair removal: a preliminary report.
Dermatol Surg. 1999 Jan;25(1):34-7.
PMID: 9935091 [PubMed - indexed for MEDLINE]

Isotretinoin responses:

Abstract
A case of ulerythema ophryogenes (KP on the face) responding to
isotretinoin (update: as little as low dose pulse accutane 10-40mg/7days/month or 10mg every day/every other day/every 4th day) [letter]

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Full Text Find Similar
Authors:
Layton AM , Cunliffe WJ
Br J Dermatol 1993 Nov;129(5):645-6

Abstract
[Ulerythema ophryogenes and folliculitis ulerythematosa reticulata]

Authors:
Layton AM , Cunliffe WJ
Br J Dermatol 1993 Nov;129(5):645-6

A case of ulerythema ophyrogenes responding to isotretinoin

Sir, We report a patient suffering from ulerythema ophyrogenes unresponsive to multiple topical therapies whose skin showed significant improvement following treatment with isotretinoin.

A 40-year-old woman presented in summer 1989 complaining of increasing roughness of the facial skin associated with reddening and soreness in the affected areas. She had first noticed the problem as a teenager. Initially, the area most significantly affected was around the lateral eyebrows and upper cheeks. Over the ensuing years, the abnormality had gradually spread to involve the whole of the cheeks, producing marked erythema. At the time of presentation, she was complaining of discomfort to the involved skin and had erythema and horny follicular plugs affecting the outer parts of the eyebrows and both cheeks. There was slight loss of hair from the lateral third of the eyebrows. There was no family history of similar skin problems and she had no scalp involvement.

Previous therapies consisted of a vast range of topical medicaments, including 4% sulphur and salicylic acid ointment, azelaic acid, several antimicrobial preparations, ketoconazole, and Retin-A gel, all of which were unsuccessful. Systemic antibiotics were also ineffective; in view of her lack of response to previous therapies, it was decided to treat her with isotretinoin at a dose of 1mg/kg/day. After a 16-week course of isotretinoin, she showed marked improvement. The horny plugs were no longer evident and the erythema had subsided. The isotretinoin was stopped at this stage.

She remained much improved for 6 months, but the problem subsequently recurred. She was therefore given a second course of isotretinoin (1mg/kg/day), and treatment continued for 5 months. This produced marked improvement again, and the benefit appears to be maintained 12 months later.

Ulerythema ophyrogenes represents a form of keratosis pilaris, which is possibly genetically determined, although many cases, as in this patient, appear to occur sporadically {1}. It typically develops in infancy, and affects the eyebrows and cheeks. Horny keratin plugs are interspersed with erythema, producing a potentially cosmetically disfiguring appearance. Associated developmental retardation has been recorded, although this is by no means universal {2}. Scalp involvement has also been described, but apparently this does not occur when eyebrows are the predominant site of involvement. Efforts of treatment are notoriously unsuccessful, although anecdotal reports have suggested that retinoids may theoretically be of value. {3}

We believe this to be the first reported case in the literature demonstrating isotretinoin as a successful treatment for this condition. The use of isotretinoin is unlikely to cure the condition but this case suggests that it may produce prolonged peroids of improvement. Provided the recommended guidelines for the use of isotretinoin are followed, repeat courses are safe, and apparently effective in the treatment of this refractory condition.

Department of Dermatology
The General Infirmary at Leeds
Great George Street
Leeds LS1 3EX. U.K.

References

1) Devenport DD. Ulerythema ophyrogenes. Review and report of a case. Discussion of relationship to certain other skin disorders and association with internal abnormalities.
Arch Dermatol 1964: 89: 74-90

2) Burnett JW, Schwartz MF, Berberian BJ. Ulerythema ophryogenes with multiple congenital anomalies. J Am Acad Dermatol. 1988 Feb;18(2 Pt 2):437-40.

3) Keratosis pilaris atrophicans. In: Textbook of Dermatology. Burton IL Vol 2 Oxford: Blackwell Scientific Publicatiions, 1992.

Followup: This patient also did report flushing in a warm environment that was much improved with the isotretinoin treatment. Current dosing suggests benefits of low dose pulse isotretinoin treatment (as little as low dose pulse accutane 10-40mg/7days/month or 10mg every day/every other day (or 5mg/day)/every 4th day(or 2.5mg/day). 5mg & 2.5mg dosing available in certain European countries or compounding pharmacies. If erythema is the main complaint the lower doses should work best where higher doses may be needed for more papules-plugging/refractory cases. As with rosacea these lower doses could improve the redness while minimizing side effects.

As mentioned in the Rosacea section: For redness/flushing, I'd recommend considering more caution than mentioned at that link with isotretinoin/Accutane dosing if considering it as suggested here Efficacy of Low-Dose Isotretinoin in Patients With Treatment-Resistant Rosacea & by the experience of Yahoo rosacea group members & thoroughly discussed in Dr. Nase's Rosacea book.

A case of atrophoderma vermiculatum responding to isotretinoin.
Clin Exp Dermatol. 1998 Mar;23(2):89-91. Review.
PMID: 9692315 [PubMed - indexed for MEDLINE]

Note: Isotretinoin/Accutane & vascular laser/IPL treatments should not be given concurrently. If accutane is started, at least 6 months after the last pill should pass before vascular laser /IPL treatments should commence as the drug can affect the healing process of the skin. One may be satisfied with the resolution of redness/erythema from vascular laser/IPL treatments so it may make sense to try it before accutane unless the condition seems to be spreading and scarring. You can work with your doctor for optimal treatment.


Stress Effects:

Neuro-psychodermatology - How can Stress (an applied force or system of forces that tends to strain or deform a body) influence your skin & vice versa?

Neurotransmitters & Flushing discussion