KP can improve in the 4th decade of life- usually mid 30s. Persistence into the 50s is not uncommon (especially for face & back of arms). Prince Willian & Harry still have KP, however it gets better with time.

Yup. The cheeks are frequently involved. This is known as KP facei (face), if there are lots of redness this is called KP rubra facei (red face). KP in this area can cause blotches that are worse with heat, social situations & blushing.

Much along the same lines as DIY treatments, exfoliating skin care acids, retinoids & physical exfoliants are prescribed by my colleagues. They use varying concentrations of the following ingredients-

• Salicylic acid: 3 to 10 %. This BHA is anti-inflammatory.
• Lactic / glycolic acids: 5-15 percent in buffered pH. Acts as an exfoliant.
• Propylene glycol: 5-10%, aids in absorption.
• Thymol: 0.5 to 2%, acts as an antibacterial agent.
• Tretinoin, retinoic acid, retinoids: This speed up turnover of skin cells
• Urea: moisturises skin, can be useful
• Anti-inflammatory steroid creams: can reduce redness, often used in a pulsed manner.

Disclaimer: I do not treat KP. My colleagues at Clinic Cutis can help. I personally do not laser KP, however you can see my nurses for treatments.

Retinoids can help some cases of KP. They work by increasing epidermal turnover, hence acting as a chemical exfoliant. My ranking from best to worse goes like this-

• Trifarotene (Akleif): Most powerful, largest pack, economical.
• Tazarotene: Powerful, needs compounding.
• Adapalene: OTC in the US, easy to get.
• Tretinoin: Great formulation, cost effective.

Read my posts on how to use retinoids, especially on the face. You can ask your dermatologist for a prescription.

Note: I do not treat KP, if you are after a prescription, please see my colleagues.

Your dermatologist can grade your type of KP according to the clinical variants. Treatments can be modified accordingly.

Keratosis pilaris pustulosa: infected pustular KP, usually affecting the legs & arms. Worse with occlusion, sweating & humidity. Best treated with keratolytics & antibacterial compounds.

Keratosis pilaris affecting the eyebrows or Ulerythema ophryogenes: rare but well-known loss of eyebrows secondary to inflammation. I occasionally get involved in this form as I can do FUE brow transfer. Your KP must be quiescent for 2 years before this procedure.

Keratosis pilaris atrophicans: atrophic divots due to KP. Inflammation takes out some collagen surrounding the hair follicle. Can be difficult to treat.

Erythomelanosis folliculitis facei et colli: pigmented brown & red variant, difficult to treat. Vascular & pigment lasers can rarely be successful.

Keratosis alba pilaris: white bumps, little red. Treated with keratolytics.

Disclaimer: If you require laser, see my nurses at Cutis Dermatology. They have extensive experience in treating this condition.

Lasers can give some improvement for keratosis rubra pilaris. The rubra means red. The results are  viable, some respond well, others do not. In most cases we use super high power with a short pulse duration. This means bruising is not uncommon.

My team employs vascular lasers & IPL to reduce the redness. Most require 3 – 4 sessions. Book a consultation with my laser nurses or colleagues at Clinic Cutis.

Disclaimer: I do not treat KP as my work is primarily surgical. My team has my laser settings & protocols for KP.

Ex-president Bill Clinton (KP worse after a Monica special), as well as the Royal Family have KP. Google this & you will see they have KP of the face (KP rubra facei). Think about this for a minute. These people have access to the best dermatologists in the world, and they still have KP. This means this condition is hard to treat.

The natural history of KP is to improve after the 4th decade of life, Prince William still has residual KP on his cheeks. 

Sun tanning reduces the look of KP.  Increased melanin hides redness. You must weigh up the balance between KP, skin cancer risk & photoaging. For darker skin patients, the risk of cancer is low, but photoaging does not discriminate against race. Be guided by your dermatologist.

Loofahs provide physical exfoliation. The ideal type depends on the location of KP, use a gentle fine grit one for your face & a coarse one for your arms-legs. Think of it as different grits of sandpaper.

A Clarisonic is a mechanical brush. It does not offer any advantages over traditional loofahs. Tip: use salicylic acid wash with your loofah, La Roche Posay or Cerave make good ones.

Yes, you might. KP runs in families & is more common in people with atopy (asthma, eczema, hay fever, allergic rhinitis).

A general medical dermatologist can help you. They can prescribe compounded topicals based upon your type of keratosis pilaris. For exceptional cases of KP rubra facei, vascular lasers & IPL can be useful in some but not all cases.

Note: I do not treat KP, please see my colleagues at Clinic Cutis.

An optimal program looks something like this-

• Exfoliation with loofah & salicylic acid washes in shower three times a week.
• Application of 20% lactic acid lotion twice a week.
• Application of 4th Generation topical retinoid once a week
• Fake tan applied properly can camouflage KP on the arms & leg

Your dermatologist may add special ingredients to the mix including chlorhexidine or thymol in summer (KP pustulosa). For special occasions, they may prescribe you an anti-inflammatory short-term or on a rotational basis. Be guided by them.