Patient's Query
Hello doctor,
I am a 30-year-old male with severe keratosis pilaris (KP) on my arms and my entire back. I have been taking treatment for it for two to three years and have not seen any improvements, even temporarily.
Initially, my dermatologist treated me with Glycolic acid at night, Salicylic acid in the morning, and 5 mg of Isotretinoin for one year, but I did not see any change. My KP slightly spread to other parts and my lipid profile became elevated.
Later, the treatment was changed to Moisturex (Lactic acid and urea) in the morning and 12 percent Glycolic acid at night, but I have not seen much improvement with this as well after one year.
My skin feels smooth with the above treatment, but the red dots are always very prominent and show no improvement.
I have now started consulting a new dermatologist, and they have prescribed 0.1 percent Tazret forte (Tazarotene) cream at night and Aquasol (vitamin A) capsule once daily.
Can you help me with the following questions:
1. Is it safe to use Tazarotene for a long time on my entire back and arms? Also, I have heard that Aquasol can cause Vitamin A toxicity. Is the dosage I am taking safe?
2. Can you recommend a non-burning moisturizer?
3. Do you think lasers or chemical peels can help with KP appearance?
4. Do you have any recommendations for me to manage my KP?
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
KPs (keratosis pilaris) are thorn-like skin projections on some parts of the body, which are genetically controlled. That means they will remain throughout life, but sometimes genes start behaving differently, so they may go away on their own, but rarely. I suggest you consult your specialist doctor, discuss with him or her, and take the medicines with their consent. In addition, you can do the following:
Isotretinoin is a standard treatment for them if severe. But in milder conditions, they can be managed with topical tretinoins like Tazarotene.
Isotretinoin causes lipid profile elevation, so cannot be used in the long term and also leads to dryness. So the best safe alternative is urea plus Lactic acid.
Use a higher concentration of urea initially, starting with 20 percent and then decreasing to 10 or five percent as per improvement.
Salicylic acid creams also help.
Tazarotene cream can also be used for long-term applications and will not cause any toxicity, unlike oral Isotretinoin. These drugs are derived from vitamin A, so can cause toxicity, but minimal with topical application. If it is causing burning, use it after a gap of four weeks. So, I suggest you use urea, salicylic acid, and Tazarotene-containing creams alternatively for four weeks.
Use ample moisturizer, like aloe vera cream.
Avoid dry weather and a humidifier if possible, as dry weather increases it.
Prolonged showers should be avoided as they wash out oils from the skin, which increases KPs.
Do not use harsh soaps.
Peels and lasers are also used to treat large lesions, but temporarily.
I would suggest you take omega-3 fatty acid 500 mg (milligrams) three times daily for four weeks then see the effect it has on some patients.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I have one more follow-up question: after one month of use, the Tazarotene is no longer burning.
However, despite moisturizing daily, my skin is flaky and red. But not at all painful.
1. Why is the redness and flakiness caused?
2. Can you recommend something to help with the skin's redness?
Even the KP lesions that are now very smooth or flat due to Tazarotene appear red and more visible.
Regarding your point about using urea, I had previously used 10 percent urea and 10 percent Lactic acid cream for one year without any change. Can using 20 percent Urea be more effective, and can I use it with Tazarotene? Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Nice to know that you are improving.
I suggest you consult your specialist doctor, discuss with him or her, and take the medicines with their consent. In addition, you can do the following:
1. Regarding redness, in sun-exposed areas, I would suggest you use a sunscreen containing Titanium and Octinoxate every three hours.
2. At other sites, use a mild steroid cream containing hydrocortisone plus Crotamiton.
3. Intermittent use, like a gap in between, will not cause steroid side effects.
4. Urea removes skin. So, a higher concentration can cause more redness. But you can try it if it suits you.
All these agents increase redness, so you have to strike a balance.
I hope this helps.
Thank you and take care.
Regards.
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