From the Guidelines
Keratosis pilaris is best treated with keratolytics, such as urea, alpha-hydroxyacids, propylene glycol, and salicylic acid, which have been shown to be superior to emollients in removing scales and hyperkeratosis. The treatment approach should prioritize the use of these agents, either alone or in combination, to effectively manage the condition 1.
Treatment Options
- Keratolytics, including urea (≥ 10%), alpha-hydroxyacids (5–12%), propylene glycol (> 20%), and salicylic acid (> 2%), are the primary treatment options for keratosis pilaris.
- Urea is the most frequently used agent, with concentrations that can be increased up to 20%, or even 40% in localized areas of thick scale or hyperkeratosis 1.
- Application of keratolytics should be done once or twice daily and can be tapered depending on the response.
- However, it is essential to note that keratolytics can cause side-effects such as itching, burning sensation, and irritation, and their application on the face, flexures, and areas of fissuring is not recommended 1.
Additional Considerations
- Regular moisturizing and gentle cleansing with non-soap cleansers can help prevent further skin dryness and promote a healthy skin environment.
- Consistent treatment for at least 4-6 weeks is necessary to see improvement in the condition.
- While complete resolution may not be possible, the use of keratolytics and other treatment approaches can significantly improve the appearance and texture of affected skin.
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.
The treatment for Keratosis Pilaris includes the use of urea (TOP), as it is useful for the treatment of hyperkeratotic conditions such as keratosis pilaris. Key points about the treatment include:
- Urea is indicated for the treatment of keratosis pilaris
- It is used for debridement and promotion of normal healing of hyperkeratotic surface lesions 2
From the Research
Treatment Options for Keratosis Pilaris
The treatment for Keratosis Pilaris (KP) involves a combination of general cutaneous measures and topical therapies. Some of the recommended treatments include:
- General cutaneous measures such as hydrating skin, avoiding long baths or showers, and using mild soaps or cleansers 3
- Topical keratolytic agents as first-line therapy, followed by topical retinoids and corticosteroids 3
- Laser therapy, particularly the QS:Nd YAG laser, which has been shown to be effective in improving the appearance of KP 4
- Topical treatments such as Mineral Oil-Hydrophil Petrolat, tacrolimus, azelaic acid, and salicylic acid, which have also been found to be effective in improving the appearance of KP 4
- Isotretinoin, which has been used to treat severe KP, although the detailed regimen for its use in this condition has only recently been described 5
- Topical lactic acid, which is the most commonly used first-line therapy for KP, followed by salicylic acid 6
- Topical sirolimus, which has been used to successfully treat Keratosis Pilaris Rubra (KPR), a subtype of KP 7
Topical Therapies
Topical therapies are a key component of KP treatment. Some of the most commonly used topical therapies include:
- Salicylic acid, which is often used in combination with other treatments 4, 6
- Lactic acid, which is the most commonly used first-line therapy for KP 6
- Tacrolimus, which has been found to be effective in improving the appearance of KP 4
- Azelaic acid, which has also been found to be effective in improving the appearance of KP 4
- Sirolimus, which has been used to successfully treat KPR 7
Laser Therapy
Laser therapy is also a treatment option for KP. Some of the most commonly used laser therapies include: