Welcome to Skin SOS With Dr. Pimple Popper (a.k.a. Dr. Sandra Lee), where your biggest skin-care questions are answered by the internet’s favorite zit-popping dermatologist. Send your skin questions to [email protected] for the chance to have your problems solved in an upcoming article.
“I have a lot of issues with KP—keratosis pilaris. I’ve had it since I was very young and I don’t know what to do to change it or help it. I’ve literally tried everything and nothing seems to work. Is it diet? Is it hormonal, is it hereditary, is it fixable in any way?” —Danielle K.
Dr. Pimple Popper: It is NORMAL, and this is why it’s hard for you to get rid of it! This is very often an autosomal-dominant trait, which means that at least one of your parents has KP and you will likely have children of your own with KP. It’s pretty common and I often have patients that say they hate the appearance and feel of these bumps.
For those unfamiliar with KP: These tiny but firm bumps (which are plugs of skin) most commonly appear on the back of the upper arms and the front of the thighs, but less commonly on the cheeks of the face and the buttocks, forearms, trunk, and legs. People try to scrub them off, scratch them off, or even try to extract them, but they grow right back. KP makes people very self-conscious, especially since they are so visible—so when our backs are turned to others, we can’t help but feel the weight of other people’s eyes staring at these bumps.
It’s not your fault you have KP. It has nothing to do with your diet, it has nothing to do with your hormones, and it is not caused by anything that you have done. You are just one of many people with this very normal skin condition. It’s not completely fixable—there’s no “cure” for it—but let me give you some suggestions on ways to help minimize the appearance and the feel of these bumps. (Note: None of these treatments are permanent, but they can help improve the look and feel of KP temporarily).
If you hate the way these bumps feel, then you should look for a product that will encourage exfoliation. You can try over-the-counter retinol products or chemical-peel acids like glycolic, salicylic, or lactic acid. You can also ask your dermatologist to prescribe you the topical prescription medication tretinoin. These all work to try to encourage more exfoliation of the skin, which will smooth out the bumps. In order to address the redness (what we dermatologists call “erythema”), you might consider trying lasers, like a pulsed-dye laser, to target redness.
If you want to look your best for a special event, you may want to apply OTC hydrocortisone to the affected areas, daily, for the week before your event. This may temporarily minimize the redness and the irritated look of KP. But know that you shouldn’t use hydrocortisone chronically because the risks of using this kind of steroid long-term (including thinning and weakening your skin) will be greater than the benefits.
“I need help! I’m 28 years old, and over the last few years, my complexion has gone from clear and beautiful to covered in large, painful zits, blackheads, and smaller whiteheads. I live in New England, where winters are long and I experience dryness, but in the summer it’s always very humid, which seems to be the worst for my breakouts. What should I do? I’ve tried everything—every cleanser, and I even stopped taking my birth control, which helped some. I’ve drastically changed my diet, and still, I get these horrible breakouts and now have scars as well. Help!” —Aysa W.
Dr. Pimple Popper: It sounds as if you’ve tried everything within your power to clear up your skin. I’m sure you’re extremely frustrated and at wit’s end. I commend you for really analyzing your situation—you sound like you understand your skin well, and how it reacts, so I understand how incredibly frustrating it can be that you can’t seem to control your breakouts.
(We also like this pimple mud from the Women’s Health Boutique to help deal with pesky breakouts!)
It’s time to see a dermatologist. As we all know, acne doesn’t threaten our lives, but it can certainly threaten our well-being. We have ammunition that you don’t have available to you to fight your acne. For example, I might prescribe to a patient suffering from similar issues a prescription retinol medication like tretinoin, topical prescription antibiotics to help lower the bacterial count on the skin, or Dapsone and Azaleic acid which are also effective in treating acne but are only available by prescription. There are also all the oral medications we use to combat acne, including oral antibiotics and even birth control. These treatments are powerful and should only be used under the supervision of a dermatologist.
Remember: Just like how your acne didn’t appear overnight, treatment also doesn’t improve your acne overnight. Be patient and persistent, and good luck.
“I have the world’s oiliest, most sensitive skin! My scalp is also super-oily, because when I don’t wash my hair, the oil slides down to the forehead. I’ve tried many, many over-the-counter face washes, home remedies, witch hazel, apple-cider vinegar, drinks, ProActiv, natural pills for acne, scrubs (natural and store-bought) and nothing seems to work. I even tried a dermatologist-prescribed Retin-A and that just dried up my skin really bad and caused a rash. HELP!” —Ivonne M.
Dr. Pimple Popper: Yes, the more oil on your face, the more you’re prone to breakouts. But look at the bright side of things: You have a naturally built-in moisturizer, and your dry-skinned friends will be complaining about their wrinkles sooner than you will because your oilier skin will keep you looking younger for longer. The challenge is to keep excess oil to a minimum on your face. If it’s the oil from your scalp and hair that’s making your face slick, tie your hair back, or change the style so that it won’t drape along your face and be sure to wash your hair more often.
You mentioned you use Retin-A; while Retin-A (a.k.a. tretinoin) is a great product, it can be irritating to the skin—as you experienced. But most people do adjust to it. Often it needs to be started slowly, maybe every other day or every third day so your skin can slowly adjust to it. Also, there are different strengths of tretinoin products, and you may need to try a lower strength. (P.S. Retin-A is primarily meant to treat blackheads, whiteheads, pimples, and pustules, not necessarily oiliness. If you don’t have these, then it is probably not that useful to you anyways.)
In general, just like we can’t control the color of our eyes, we can’t really control the oiliness of our skin. However, there are some prescription medications a dermatologist can recommend to you that are fine-tuned to your specific situation. Spironolactone is an anti-androgen, meaning it helps to inhibit testosterone in our bodies (men and women have testosterone but if there is a little excess in women this can cause breakouts and oily skin) and thereby reduces oiliness and acne. Isotretinoin (not to be confused with the above-mentioned tretinoin, which is a topical medication), is an oral medication that inhibits our oil glands. It is the most potent medication we have to fight acne and is usually reserved for more severe cases. Both of these medications need to be monitored over time by the physician. I recommend that you follow up with a dermatologist to help you find the right solution for your needs.