expert advice: from dr. neal schultz, dermtv.com

Attention all moms of toddlers: You may be wondering why your knees have been feeling a bit dry and scaly lately. Maybe because you're always kneeling to clean dirty faces, feed hungry mouths or pick up and put away loose toys? In fact, there's a good chance your two- or three-year old has been keeping you on your knees pretty often. I asked Dr, Neal Schultz, cosmetic dermatologist and host of dermtv.com for some expert advice...

“Dry rough patches on the knees is really not dry skin at all," he says, "but rather thickened skin which has so many layers of dead cells that it appears scaly or flaky. From the presence of scales or flakes, we are misled to believe that it's dry skin but scales/flakes are the result of many different problems or conditions…in this case from thickening of the skin."

He explains that "dry” rough patches on the knees occurs because of one of two reasons: Either an inherited, genetic basis (it tends to run in families) or from rubbing the skin of the knees either by kneeling on your knees or anything else that causes repeated pressure or rubbing of the knees.

Since it really represents extra thickened dead skin, moisturizers won’t work, and most over the counter callous creams just aren't strong enough exfoliants to dissolve that extra thick dead layer of cells. Louffa is a fairly gentle form of physical exfoliation and probably not powerful enough to help this although if used in combination with stronger chemical exfoliants may be helpful. "For this I recommend chemical exfoliants and, in particular, potent glycolic products as they are strong enough to do the job and yet not cause irritation of the surrounding skin if used properly and as directed," says Schultz. "The cream that I recommend for my patients is Stallex Glycolic Therapy 20 cream for feet which is a 20% glycolic product used for excessive thickening of dead skin on feet, knees, elbows and knuckles. Because it’s pretty strong it must be used in a very small amount very lightly twice daily, avoiding the surrounding skin. After applying it, any cream on the fingers should be rinsed off. Allow approximately two to four weeks to see improvement. If the problem is on the basis of a hereditary tendency then the cream needs to be used on an on-going basis. If the thickening of the skin on the knees is from excessive rubbing (like callous formation) then if the rubbing that causes the thickening is stopped, then treatment with the cream is no longer necessary. For less resistant cases I recommend Stallex Glycolic Therapy 15 gel, used the same way. Other less potent treatments include any over-the-counter 5% to 12% glycolic products again used twice daily but usually that strength is not as effective at removing the type of thickened skin that appears on the knees."

For more expert advice and answers to your most pressing dermatology questions, visit www.dermtv.com.

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