Keratosis Pilaris: Treatment Practices of Board-Certified Dermatologists

October 2023 | Volume 22 | Issue 10 | 985 | Copyright © October 2023


Jonathan Greenzaid BSa, Dillon Nussbaum BSb, Adam Friedman MD FAADb

aGeorgetown University School of Medicine, Washington, DC
bDepartment of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC

Abstract
Keratosis pilaris (KP) is a chronic disorder of follicular hyperkeratinization and perifollicular erythema with lesions affecting the extensor surfaces of arms, upper legs, and buttocks. While there is some evidence that laser therapies and topical therapies such as lactic acid reduce the follicular papules of KP, support is limited with respect to which topical treatments dermatologists utilize and their perception of efficacy. A 16-question survey was distributed to a random sampling of the ODAC Conference listserv to determine which topical treatments dermatologists utilize the most, the duration of therapy needed with various treatment modalities, and the effectiveness of topical and laser therapy for treating KP. Our study found topical lactic acid is the most used first-line therapy for KP (43.63% of survey respondents), followed by salicylic acid (20.72%). Laser therapy is only utilized by 8.76% of survey respondents, with a lack of insurance coverage and proper equipment limiting its use. KP is often recalcitrant to treatment, and our study demonstrated that over 60% of respondents found recurrence of KP lesions within three months of stopping salicylic acid treatment and OTC moisturizer treatment. The data herein can be used to better utilize the selection of topical and laser therapies for the treatment of KP.

J Drugs Dermatol. 2023;22(10):985-989 doi:10.36849/JDD.7534

INTRODUCTION

Keratosis pilaris (KP) is characterized by hyperkeratotic folliculocentric papules distributed on the arms, upper legs, and buttocks.1 It commonly occurs with perifollicular erythema. The papules and erythema are benign but can lead to psychological distress in patients who find the papules cosmetically unappealing. Topical therapies are shown to be effective at reducing hyperkeratosis in KP. For example, 50 patients treated for 12 weeks with 10% lactic acid versus 5% salicylic acid had a 66% and 53% reduction in papules, respectively by the study's end.2 However, many of these clinical studies do not have long-term follow-up3, and KP is often recalcitrant to many of these topical therapies. In one study, 25 participants were treated with 50% and 70% glycolic acid solution over 2 months. After 2 months of treatment, there was an average of over 50% reduction in keratotic papules in the treatment group. However, at a 5-year follow-up, the number of keratotic papules remained unchanged compared to day 0 of treatment.4 In light of treatment limitations, newer approaches to management, such as Q-switched Nd:Yag and fractional CO2 lasers have been employed. Several small studies have demonstrated that treatment with QS Nd:Yag decreases keratotic papules and erythema of keratosis pilaris,8,9,10 though utilization in the dermatology community has not been assessed. Even beyond the gaps in evidence-based treatments, there is no available information about how dermatologists employ the current armament, nor the perceptions of treatment efficacy and durability. A 16-question survey was developed and disseminated to determine dermatologists' first-line treatment for KP, perceptions of the effectiveness of different topical and laser therapies, and the duration of treatment required for disease clearance and sustainability of disease resolution.

MATERIALS AND METHODS

A 16-question Qualtrics survey was distributed to a random sampling of the ODAC Conference email listserv from October 24 through November 7, 2022. 251 respondents completed the survey (12.55% response rate, Table 1). The George Washington School of Medicine IRB approved the study on 10/07/22 (NCR224513). Chi-squared analysis was used to determine associations between demographic data and the selection of first-line treatment of KP. More specifically, we analyzed whether there was an association between selecting the first-line treatment of lactic acid or salicylic acid, and the demographic categories of years in clinical practice, clinical focus, and practice setting. We analyzed if there was an association between gender versus the selection of lactic acid, OTC moisturizer, salicylic acid lotion, and urea cream as first-line therapies for KP. Fisher's exact test was used to analyze if there was an association between the demographic data of clinical focus and practice setting, versus the practitioner's first-line treatment for KP.
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