From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails. Clinical Pharmacology Urea gently dissolves the intracellular matrix which results in loosening of the horny layer of the skin and shedding of scaly skin at regular intervals, thereby softening hyperkeratotic areas of the skin.
Topical compounds for Keratosis Pilaris in the USA include:
- Urea (TOP), which is useful for the treatment of keratosis pilaris, as it gently dissolves the intracellular matrix, loosening the horny layer of the skin and shedding scaly skin, thereby softening hyperkeratotic areas of the skin 1 1.
From the Research
For treating Keratosis Pilaris (KP) in the USA, I recommend using topical exfoliants containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs), with lactic acid being the most utilized first-line therapy, as reported by 43.63% of survey respondents 2. Specifically, products with 10-12% lactic acid, 2% salicylic acid, or 10% urea are most effective. Popular over-the-counter options include:
- CeraVe SA Cream
- AmLactin Daily Moisturizing Lotion
- Eucerin Roughness Relief
- The Ordinary Glycolic Acid 7% Toning Solution Apply these products once or twice daily to affected areas after showering when skin is still slightly damp. Consistency is key, as KP requires ongoing management rather than a one-time treatment. Most people see improvement within 4-6 weeks of regular use. These ingredients work by gently dissolving the keratin plugs that cause KP bumps while moisturizing the skin. Combining chemical exfoliation with gentle physical exfoliation (using a soft washcloth) once or twice weekly can enhance results. Additionally, avoid hot showers, wear loose clothing, and maintain skin hydration, as KP often worsens in dry conditions or with skin irritation, as supported by the recent review on KP management 3. It's also worth noting that laser therapy, particularly the QS:Nd YAG laser, has been shown to be effective in treating KP, but its use is limited due to lack of insurance coverage and proper equipment 4. A high concentration of glycolic acid has also been shown to improve skin roughness and follicular hyperpigmentation in patients with KP, but the treatment was relatively safe, with no significant difference at the 5-year follow-up compared to before treatment 5. However, based on the most recent and highest quality study, topical lactic acid remains the most recommended first-line therapy for KP 2.