Managing Keratosis Pilaris with Lactic Acid



by Alan Fleischer, Jr., M.D.

Have you ever noticed small, acne-like, red bumps on your arms, thighs or buttocks often accompanied by dry patches of skin that look and feel like sandpaper? If so, you are not alone. In fact, the American Academy of Dermatology estimates as many as 20 percent to 40 percent of the population may suffer  from a skin disorder known as keratosis pilaris (KP), which is caused by protein in the skin, called keratin, forming hard plugs within the hair follicle.

KP often raises its ugly head during the teenage years and can persist into adulthood. Small bumps, sometimes surrounded by a pinkish hue, are often the first symptom associated with KP, and are usually accompanied by dry skin. While the cause is unknown, KP tends to be genetic. The disease is most prominent during the dry skin season, from October to March, and can be exacerbated by cold air.

As a practicing dermatologist, I see many patients looking for relief from the dry skin associated with KP. KP is best managed with moisturizers containing lactic acid. Lactic acid is a humectant that helps the skin retain moisture and at the same time exfoliates and softens the skin. Not all moisturizers contain lactic acid so it is very important to check the product label.

Lactic acid has been used for decades, and dermatologists have extensive experience with this exfoliant.  The challenge in formulating lactic acid for moisturizers is to maximize the concentration of the exfoliant while minimizing the potential for burning and stinging. Acidic products can cause stinging on sensitive skin and careful formulation approaches minimizes this potential. In addition, virtually all ingredients applied to the skin have the potential to be absorbed systemically or in the bloodstream. However, if one applies lactic acid containing lotions to normal skin or KP, the absorption is so trivial as to be of no concern. Because of their proven safety, FDA allows lactic acid to be used in over-the-counter (OTC) moisturizing products.

There is no area of active research surrounding new ways to treat KP. AmLactin® XL was developed with a combination of multiple different lactic acid exfoliants, which allows for greater concentrations of the alphahydroxy acids. Although not proven, other alphahydroxy acids such as glycolic acid likely work to treat KP. The retinoids Retin-A Micro or Renova, Differin, Tazorac or Avage, and possibly retinol, likely help as well. These acne and photoaging drugs act differently than the alphahydroxy acids, possibly synergistic, but are far costlier and require a pregascription. 

There is no cure for KP, but the good news is with proper daily skin care, KP sufferers can manage KP and potentially minimize outbreaks. Here are a few practical tips:

  1. Keep your skin hydrated and moisturized daily.
  2. Avoid hot showers or baths as they can dry out skin and encourage symptoms of KP. 
  3. Avoid heavily scented soaps and cleansers. 
  4. Wash with mild ingredients and non-scented products. 
  5. Add a humidifier to your home or bedroom, especially if you live in a particularly dry area. 
  6. Don’t scratch the affected area of the skin. Scratching can cause irritation and increase the likelihood of infection or redness. 
  7. Not all moisturizers are alike. KP is best managed with moisturizers containing lactic acid, which is a humectant that helps the skin retain the moisture and at the same time exfoliates and softens the skin. Not all moisturizers contain lactic acid so it is very important to check the product label. One moisturizer with lactic acid for severe dry skin is AmLactin®, which when applied twice daily on skin affected by KP can help manage the dry skin associated with KP.

KP can seem like a nagging problem, but when tended to daily, signs and symptoms can be kept under control. For additional information about KP visit, the official Web site of the American Academy of Dermatology.

Alan Fleischer, Jr., M.D., is the professor and Chair of the Department of Dermatology at Wake Forest University School of Medicine in Winston-Salem, N.C., director of the General Dermatology Clinics, and co-director of the Center for Dermatology Research. He trained as an undergraduate and medical student at the University of Missouri-Columbia. He has published five dermatology textbooks, more than 250 peer-reviewed articles, and has presented results from his research and medical care throughout the United States and on multiple other continents. Since 2000, he has been selected by his peers as one of the “Best Doctors in America.”



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