Senin, 24 Desember 2012

Natural Treatment For Keratosis Pilaris



Natural Treatment For Keratosis Pilaris, 
Check the definitive guide here
 Natural Treatment For Keratosis Pilaris  


1 - CLINICAL DIAGNOSIS

Pilar keratosis are a group of disorders resulting clinically by the presence of protruding elements, gray and members, located at the follicular ostia, giving the sensation of touching a grater.

1.1 - SIMPLE KERATOSIS PILARIS

It is a benign, common, autosomal dominant with variable penetrance, more common in females. The lesions are mainly located on the outer side of the arms and thighs, and cheeks. There sometimes an inflammatory reaction with perifollicular redness. The lesions appear in childhood and usually disappear in adulthood they improve in the summer half of the cases. Keratosis pilaris is often simply associated with ichthyosis vulgaris and atopy. A genetic origin is suspected because of the association between keratosis pilaris and partial monosomy of chromosome 18 [ 1 ] .

Histological examination shows no interest (hyperkeratosis of hair follicle ostia). There is no anomaly associated biological. The damage is only cosmetic

1.2 - pilar keratosis ACQUIRED

They can be seen in many dermatoses: follicular lichen planus, psoriasis follicular tuberculids follicular eczema follicular sarcoidosis follicular follicular mucinosis, dermatomyositis, vitamin A or C (scurvy), secondary syphilis spinulosique some pilar dysplasia (monilethrix, pili torti, hereditary hypotrichosis Pierre-Unna) acrokeratosis verruciformis of Hopf.

1.3 - KERATOSIS PILARIS atrophic

It is characterized by follicular keratosis lesions progressing to atrophy and rarefaction final appendages.

 Natural Treatment For Keratosis Pilaris. Various syndromes including a keratosis pilaris atrophicans are described [ 2 ]  : the Ulerythema ophryogène the follicular keratosis spinulosique decalvans of Siemens, atrophodermia Vermiculata, folliculitis decalvans of Quinquaud.

These syndromes are differentiated by the location and severity of inflammation. Some authors consider these syndromes as a single entity.

 2 - PHYSICAL AND PSYCHOLOGICAL impact

It is sometimes important, especially in extended forms. Pilar keratosis can cause skin discomfort, disfigurement and psychological impact.

 3 - PATIENT INFORMATION

It is a benign condition. Treatment is symptomatic and suspension. Improvement with age is common. In keratosis pilaris atrophicans, achieving dander is final.

 4 - TOOLS OF TREATMENT

Use the tools described in this chapter. The level of evidence is low because there are few clinical studies.

4.1 - GENERAL MEASURES

It is recommended that:

- Avoid too frequent facials;

- To prefer showers with warm water to hot baths;

 Natural Treatment For Keratosis Pilaris  
- Use soap surgras and humidify the atmosphere;

- Apply different treatments on skin moistened.

Some authors also recommend that you apply different local treatments and massage gently with an abrasive sponge.

4.2 - Emollients and Moisturizers

By themselves they are rarely effective enough. However, their application can improve the suppleness of the skin and reduce the skin feeling dry and tight.

Some preparations exert this action by "occlusive" are fats hydrophobic. Other products are highly hygroscopic and improve the hydration of the stratum corneum: these sodium lactate and pyrrolidone carboxylic acid or urea, polyols (glycerol, propylene glycol or sorbitol) and glycerin .

The only emollient is repaid Dexeryl ® . Magistral preparations are partially reimbursed (the carrier is in charge of the patient). To obtain reimbursement, it should be noted on the prescription: "Compounding for therapeutic use, in the absence of equivalent specialties available." Among the compounding include: cerate Galen (white wax 130 g, 535 g almond oil, distilled rose 330 g sodium borate and 5 g) and the preparation of starch glycerol (glycerol starch 20 g, neutral Excipial lipolotion qs 200 g).

4.3 - MODIFIERS OF THE KERATINIZATION

KERATOLYTIC

These include salicylic acid, urea and the a-hydroxy acids.

SALICYLIC ACID

It has a stripping action whose intensity depends on the concentration of salicylic acid, but also to the nature of the excipient and of any occlusive effect. The concentrations used vary from 5 to 20 percent. 100 in petrolatum, 5 p. 100 in a cold cream. There is a potential for high concentrations irritating. This treatment should be used with caution and in small areas in young children due to the risk of skin absorption and systemic effects (metabolic acidosis).

Magistral preparations, which here is an example, can be used:

- The salicylic vaseline  : salicylic acid 3 g and 100 g vaseline.

The repayment terms are the same for emollients.

UREA

It has the stratum corneum action both moisturizing and keratolytic (lower than salicylic acid). It can be used as a gel, cream or ointment of 10 to 30 percent. Urea 100.

Among the compounding include the following:

60 g urea, 40 g purified water, qs 200 Excipial lipolotion neutral g.

There are also some preparations available non-reimbursed urea:

- Kératosane ® (urea 15 or 30 p. 100), which the marketing authorization for adjunctive treatment of hyperkeratosis;

- XERIAL ® 5, 10, 30 or 50 (urea 5, 10, 30 or 50 p. 100).

Regarding the use of urea in children, there are some publications related elevated plasma urea in collodion babies. It seems prudent, in a child less than 1 year, not to apply a topical containing urea throughout the body.  Natural Treatment For Keratosis Pilaris

PREPARATIONS CONTAINING A-HYDROXY ACIDS

The a-hydroxy acids are organic acids having a hydroxyl function adjacent to a carboxylic function. They are found naturally in some fruits. At acidic pH, they have a role kerato, increase desquamation and promote cell renewal. They also act on hydration. Their activity depends on the choice of the a-hydroxy acid, the pH and the concentration of the free acid form. These products are not reimbursed, and their effectiveness in pilar keratosis has not been established.

An example of preparations available:

- Ikériane ® (guanidine glycolate, petrolatum and glycerin);

- Lacticare ® (lactic acid), propylene Lacticare ® (lactic acid, propylene glycol and glycerol).

Some preparations (not refunded) both contain a combination of active ingredients: urea and lactic acid: Topic 10 ®  , urea, lactic acid, salicylic acid (cream Akérat ® ).

RETINOIDS

Retinoids are synthetic substances derived from vitamin A, which act as modifiers of keratinization.

VITAMIN A ACID (TRETINOIN OR)

• Local Port  : Vitamin A acid can be used 0.05 or 0.1 percent. 100, in solution or cream. It frequently causes side reactions irritating. Vitamin A is teratogenic oral use is cons-indicated during pregnancy.

Some preparations as Effederm ® cream 0.05 percent. 100 are reimbursed and the MA in keratinization disorders resistant to emollients.

• Channel General  : retinoids are available acitretin (Soriatane ® ) which has the AMM for disorders of keratinization, but only severe (see Chapter systemic retinoids) and isotretinoin (Roaccutane ® , Curacné ® and Procuta ® ) which has the MA in acne. This treatment should be special treatment.

TAZAROTENE

Tazarotene (Zorac ® gel 0.1 or 0.05 p. 100) belongs to the class of acetylenic retinoids. It is a prodrug converted in the skin acid which tazarotenic rétinoïdique activity. He did the MA in psoriasis. Gerbig [ 3 ] reported its effectiveness in an open study on 20 patients using an emulsion at 0.01 p. 100, 1 time per day for 1 to 2 months.

4.4 - PUVA

Some pilar keratosis improve spontaneously summer. The beneficial effect of summer sun exposure may be extended by PUVA in winter. However, this positive effect is offset by long-term adverse effects of UVA rays.

4.5 - CALCIPOTRIOL

It has no authorization in this indication. It was considered ineffective in nine patients with keratosis pilaris [ 4 ] .

4.6 - topical corticosteroids

Topical corticosteroids may be used at the beginning of treatment, only to decrease inflammation.
 

4.7 - TOPICAL TACROLIMUS

Topical tacrolimus (Protopic ® ) did not show superiority compared with emollients when used at 0.1 p. 100 in 30 patients, 2 times a day for 6 weeks [ 5 ] . There is more than one off-label prescription.

 5 - THERAPEUTIC STRATEGY

The therapeutic strategy is based on the clinical forms.

5.1 - SIMPLE KERATOSIS PILARIS

When there is no disfigurement or achievement is narrow, no treatment is necessary.

When keratosis is broader or more disabling, a dermatological care is necessary [ 6 ] . General measures should then be instituted.

If inflammatory flare, a dermocorticoid middle class can be used, only the top one to two times daily for one week, combined with emollients. The relay is made by preparing 2 or 3 p. 100 salicylic acid in a cream at 20 p. 100 urea (see precautions children). The preparation should be applied by gentle massage using an abrasive sponge. If the condition is well controlled, two to three applications per week is sufficient. After several weeks of adequate control, it is possible to move applications to the urea cream 20 p. 100, regular and indefinite.  Natural Treatment For Keratosis Pilaris, 
 Natural Treatment For Keratosis Pilaris
PUVA may make improvements transient but its use should be limited.

Topical retinoids may be prescribed either in isolation or in combination with other treatments emollients and keratolytic. The combination with topical steroids may allow departing from reducing irritative effect.

The retinoids are usually reserved for severe disorders. They can be prescribed for short periods in diseases in general form follicular beginning of treatment. The relay is made by other treatments emollients and keratolytic.

5.2 - pilar keratosis atrophic

Keratolytic agents and topical corticosteroids, sometimes in class I, can be applied under occlusion. The effectiveness of isotretinoin 1 mg / kg / day for 4 months was considered poor (inconsistent and weak or possible worsening) [ 7 ] . The pulsed dye laser was also tested in an open study of 12 patients [ 8 ] . Effectiveness of erythema was observed in all patients, and 10 patients roughness. The treatment was well tolerated.