From the Guidelines
The best treatment for keratosis pilaris is the use of keratolytics, such as urea (≥ 10%), alpha-hydroxyacids (5–12%), propylene glycol (> 20%), or salicylic acid (> 2%), alone or in combination, to remove scales and hyperkeratosis. According to the European guidelines of care for congenital ichthyoses, part one, published in the British Journal of Dermatology in 2019 1, these agents have been shown to be superior to emollients in removing scales and hyperkeratosis.
Some key points to consider when using keratolytics for keratosis pilaris include:
- Urea is the most frequently used agent, and its concentration may be increased up to 20%, even 40% in localized areas of thick scale or hyperkeratosis
- Keratolytics are usually applied once or twice daily and can be tapered depending on the response
- Side-effects include itching, burning sensation, and irritation, and application on the face, flexures, and areas of fissuring is not recommended
- The use of alpha-hydroxyacids, such as glycolic acid or lactic acid, or beta hydroxy acids, such as salicylic acid, can also be effective in removing dead skin cells and smoothing the skin's texture
It is essential to note that keratosis pilaris is a chronic condition that can be managed but not permanently cured, and consistency is crucial in treatment. Improvement typically takes 4-6 weeks of consistent treatment.
From the FDA Drug Label
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. 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.
The best treatment for keratosis pilaris is urea (TOP), as it is useful for the treatment of hyperkeratotic conditions, including keratosis pilaris, by loosening and shedding the horny layer of the skin, thereby softening hyperkeratotic areas 2 2.
- Key benefits of urea (TOP) for keratosis pilaris include:
- Softening of hyperkeratotic areas
- Loosening and shedding of scaly skin
- Promotion of normal healing of hyperkeratotic surface lesions.
From the Research
Treatment Options for Keratosis Pilaris
The treatment for keratosis pilaris (KP) can vary depending on the severity and type of the condition. Some of the most effective treatments include:
- Laser therapy, particularly the QS:Nd YAG laser, which has been shown to be the most supported form of treatment for KP 3
- Topical treatments, such as:
- Moisturizing creams, such as a 20% urea cream, which can help to improve skin texture and reduce the appearance of KP lesions 5
- Other treatments, such as microdermabrasion and pulsed dye laser therapy, which may be effective for patients who are refractory to topical therapy 6, 7
Effectiveness of Treatments
The effectiveness of these treatments can vary depending on the individual patient and the severity of their condition. Some studies have shown that:
- Laser therapy can be highly effective in improving the appearance of KP lesions 3
- Topical treatments, such as salicylic acid and lactic acid, can be effective in reducing the appearance of KP lesions, but may require ongoing treatment to maintain results 4
- Moisturizing creams, such as a 20% urea cream, can be effective in improving skin texture and reducing the appearance of KP lesions, with significant improvements seen after just one week of use 5
Treatment Practices of Dermatologists
A survey of board-certified dermatologists found that:
- Topical lactic acid is the most commonly used first-line therapy for KP 4
- Salicylic acid is also a commonly used treatment for KP, but may require ongoing treatment to maintain results 4
- Laser therapy is not as commonly used, due to limitations such as lack of insurance coverage and proper equipment 4