I have redness on my cheeks since I was 11 and it only got worse as I got older now (28). tried accutane, no help waste of time because its proven that supplemental vitamin A does not help this problem. at first I was diagnosed with rosacea at 24 got a 2nd opinion and told the same, and a 3rd, 4th, 5th opinion untill I went to Univ of Penn hospital for a biopsy. the biopsy reveals mild perifollicular fibrosis and lymphocytic inflammation within the region of follicles. no medications or creams seem to work, the only thing that is proven to work that I found online is PDL treatments at certain settings might do the trick to remove atleast the rednessJournal of Cutaneous Laser Therapy 2000) but only some of the roughness if any exists. I went to a grand rounds at Penn after my derm diagnosed me, and he decided to put me on accutane 10mg a day, i did the blood test every month since u have to, but no difference so i came off back in march 07. I found a new derm who does the treatments and Im bringing him this article i printed online to show him the settings for this unknown conditon. you all should talk to your derms and see if he or she can put these treatments under your insurance because its more than a cosmetic issue it starts to become a mental issue as well for some. he or she can always tell the insurance co. its a hemingioma that he is treating and it can then be covered under insurance, but make sure the derm is a nice person with a good bed side manner and see if he or she can do this for you. so you dont have to pay out of pocket. i mean after all derms dont see this conditon often so if something were to help a rare conditon and it can be coverd under insurance with a little compassion, then why not.
see I have KP on my arms, legs, butt but it does not bother me at all, all those people with KP only on their limbs should consider themselves lucky. because that is the common conditon, KPA or KPRF and UO are a group of conditons which is a variation of stand KP!

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Hi there,

what is "mild perifollicular fibrosi and perifollicular lymphocytic inflammation"??? I tried looking it up online and got stuff i couldn't understand about scalps? Could you please explain it, where it affects you, what it looks like, etc?
Thank you!

if you have KPA on your cheeks then it looks like a red blushed look or a mild sunburn.
i have eryethema which is a doctor term for abnormal redness on the cheeks (KPA) mostly in my beard area (cheeks ). I cant explain lmphoctic inflammation I only read about it, but its basically inflammation that has to due with your lymphoctes. type a defintion on lymphocytes.

its very hard to understand biopsy reports but i asked for copies of mine to research. read the article for PDL treatments for KPA with certain settings.

Hi Jason

KPA and KPRF are two distinct keritinization disorders - I kind of gathered from your post that you thought they were the same

KPA or KPAF as I call it is Keratosis Pilaris Atrophicans Faciei and as you said effects the top of the cheeks leaving the skin looking pitted and very red. This is a scarring condition that produces permament redness and pitting.

KPRF is keratosis pilaris rubra faciei which are the small kp bumps that tend to occur on the lower sides of your cheeks and contribute to flushing (KPRF does not cause scarring to the skin whereas KPAF does)

It sound like you have both KPAF and KPRF (this is the same with me but I also have UO on eyebrows)

PDL laser treatment has helped my KPAF redness considerably. The KPRF has faded with age (am now 46).

I hope I haven't confused things for you but as you pointed out these conditions are quite rare so often the terms for them can get muddled.

I suppose i would have KPRF? I basically have bumps that cover my entire face, not just lower cheeks. Side of my face, bit on my chin, whole forehead, etc.

I have no pitting what so ever or scarring on my cheeks . as a matter of fact my skin is smooth but with redness, I have some bumps along my jawline from the KPA OR KPRF. but dont think that there are to many distinctions between KPA and KPRF or even UO. they are all KP variations with inflammation and they atrophy the skin hence the redness. UO is the same thing inflammation in the eyebrows which is terminal hair. and the cheeks whether you are man or female beard or no beard there is still follicles there but they are tellogen hairs (peach fuzz) which is affected. im getting hair removal done on my cheeks then 2-8 PDL treatments according to the settings in the article above in the post (2000 journal)

please if you have not read this then read it :Journal of Cutaneous Laser Therapy 2000)

Yes I agree they are all keritinizaiton disorders but they are distinct and can exist together or seperately. KPAF on the cheeks (or atrophoderma vermiculata as it is also known) is quite rare. Over the 5 years on this site there have only been about 5 people diagnosed with it. The article you refer to talks about KPAF (atrophoderma vermiuclata). I came across the guy who originally posted this article on the net about 7 years ago and it was through this article that I got the PDL treatment for my KPAF. However I know of no article that talks about results of PDL treatment on KPRF. That does not mean it won't help - however if you have KPRF you cannot base results on this medical article.

Both UO and AV come under the heading of Keratois pilaris atrophicans faciei as they actually permanently scar (or atrophy) the surface of the skin. The redness from KPRF is mainly due to the inflamed hair follicules whereas KPAF severely damages the blood vessels and dermis. When having my PDL treatment done in my UO and AV areas the derm said my skin there was like a port wine stain.

If you look at the top of my cheeks and eyebrows you will see the redness and scarring from these conditions. The areas that had KPRF in my teens and twenties are not scarred at all.

I think it is important when getting a diagnosis from a derm to get them to tell you exactly what you have as the end results of these conditions vary as do the treatments. However because KPRF, UO and AV are not that common derms can get the terms mixed up.

Hi anne,

can u elaborate on your treatments, was it PDL ?

were they at the settings from the article or did you leave that up to the doctor ?

how mant treatments have you had at first ?

has your skin remained normal complexion after treatments or did it eventually start to go back to redness ?

if so, did you have more treatments ?

on a scale of 1-10 what was your redness pre-treatment?

on a scale of 1-10 what is your compexion after treatments ?

you had PDL for UO in your eyebrows, do u have any hair in your eyebrow area ?
also check out Keratosis Pilaris. DermNet NZ if you have not already. they have a pic and class for every variation of KP.

regards, Jason

thanks for your knowledge, I to feel like a freakin med student with research on my own since doctors dont elaborate on these disorders.

Hi Jason

I know what you mean - it took me 21 years, six dermatologists in 6 different cities and in 2 different countries to finally get a diagnosis!

I have Atrophoderma vermiculata on the top of my cheeks and UO on my eyebrows (these two conditions come under the heading of KPAF)

I also had KPRF in my teens and twenties along with normal KP (these began to fade in my 30's)

Now to answer your questions:

I have had two PDL treatments done using the Candela Vbeam pulsed dyed laser. One was about 6 years ago and the other was about 2 years ago

Settings were left up to the Dermatologist - he seemed quite experienced. I think he used a higher setting on the areas where redness occured from the AV and UO (he said these areas reacted to the laser like a port wine stain)

The rest of my cheek was also red (but not as much as the top part). My mother has naturally high colouring so I am not sure if the redness was this or in fact caused by the KPRF. Anyway he used a lower setting in this area. Apparently they can tell by doing a few test spots what is the best.

Yes my skin has remained improved following these treatments. However the first was done about age 39 and the condition was no longer inflammatory. If your KPRF, KPAF is still active you may find that redness does return - however I think the article you quoted does mention that by normalising the blood vessels it could prevent further progression of KPAF

I would say my redness would have been 8/10 - after two treatments it is probably about 4/5 out of 10. Because the PDL can only target so many blood vessels at a time you end up with a fading of the redness. i.e. my skin used to be red but now it is a dark pink. I will probably need two more treatments to get near normal but as the medical article you posted shows this may not be able to be achieved. However since the writing of this article the lasers have improved significantly so I would expect better results than reported there.

I had PDL treatment in the eyebrow area. I would say the cheeks responded better. I have lost the hair on the outer third to UO and this is the area that is very red. I sometimes wonder if my UO is still active as this area gets itchy and can still flare up. PDL does not cause hair loss so you should get this area treated also.

Just to clarify - did your derm use the term KPAF? - did they mention atrophoderma vermiculata (this is KPAF on the cheeks)? I can appreciate how confusing these terms can be and unfortunately because of its rarity most derms don't know exactly what name fits what.

Do you think you have both KPRF and AV on the cheeks?

You obviously have UO - that is the easier one to diagnose.

I hope I haven't bombarded you with too much info - I must have read every article on the net regarding these conditions and I have info from NORD (national order of rare diseases) so feel free to ask.

Regards
Anne

Hi again - just thought I have better check the dermatology NZ site you posted - the picture of KPAF looks like KPRF to me. It doesn't surprise me though as I am a NZ'er and like I said the derms here don't know a lot about it - it took a visiting South African Dr to finally diagnose me.

Here is a copy of a post I made a while back which shows a picture of atrophoderma vermiuclata (aka KPAF on the cheeks). This is an extreme case - my pitting is not so noticeable however because my skin is quite fine and thin the redness on me was more noticeable.

this article is similar to the one you posted and appears on the same site but it is written by a group of American Drs. It shows the same results though for PDL on atrophoderma vermiuclata

"Pictures of Atrophoderma Vermiculata

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There are a few people on the site who have been diagnosed with KPAF recently (Keratosis Pilaris Atrophicans Faciei). This can include atrophoderma vermiuculata (AV) and/or ulerythema ophryogenes.

Since AV is not that common I thought it might be helpful to post an article which has pictures as well as afterphotos showing the effect of PDL treatment.

Periodicals Home

I have AV but my pitting is not as marked as those in the photos.

Hope this is of some help to someone

hey anne,

I know I have KPRF I even told the derms that, as they told me its rosacea probably because there are more treatments for that, and KP variations are hard to talk about. my cheeks are like a light pink that turn to a dark pink at times, even when in the heat exposure. and my skin type is 4, which is not fair skin but on the lighter side of olive skin.
the article I posted talks about KPA, but the pictures look like KPRF and I was mainly interested in the effects of the PDL on the differnt degrees of reddness. which are pretty good, (one person in that group had complete clearance) went from a 4 to a 0 , thats good for him or her.

thanks for the added info and answers.

U should try witchazel on ur eyebrows, pour some on cotton and wipe 2 times or so, let it dry and put on aloe vera cream by (vaseline) and ask your derm if you can get a Rx for CLOBEX (clobetasol propionate) shampoo for ur eyebrows use maybe twice or three time week. beleive me I never used a singe steroid anything but this stuff has no side effects at all, used it for my scalp sometimes.but talk to your derm and tell him.

Your results may not be the same as the articles however as both the one you posted and I posted were the effects of PDL on KPAF (not KPRF).

A few with KPRF have tried PDL but often you don't hear back from them after treatment. You may want to have a search on this site for them.

All the best

Anne