From the Guidelines
Keratosis pilaris can be effectively managed with keratolytics, such as urea, alpha-hydroxyacids, propylene glycol, and salicylic acid, which have been shown to remove scales and hyperkeratosis more effectively than emollients. When managing keratosis pilaris, it is essential to consider the use of keratolytics, as they have demonstrated superiority over emollients in removing scales and hyperkeratosis 1. Some key points to consider when using keratolytics include:
- Urea is the most frequently used agent, with concentrations that may be increased up to 20%, or 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 of keratolytics include itching, burning sensation, and irritation, and their application on the face, flexures, and areas of fissuring is not recommended due to the risk of irritation 1. In clinical practice, the choice of keratolytic agent and its concentration should be individualized based on the patient's specific needs and response to treatment. It is also important to note that keratosis pilaris is a chronic condition, and ongoing maintenance is necessary to prevent recurrence. By using keratolytics and other management strategies, such as gentle exfoliation and consistent moisturizing, patients with keratosis pilaris can achieve significant improvement in their symptoms and quality of life.
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.
Management of Keratosis Pilaris can include the use of urea (TOP), as it is useful for the treatment of hyperkeratotic conditions such as keratosis pilaris 2.
- Urea can help with debridement and promote normal healing of hyperkeratotic surface lesions.
- It is recommended for the treatment of hyperkeratotic conditions, including keratosis pilaris.
From the Research
Management of Keratosis Pilaris
Keratosis pilaris (KP) is a common skin condition characterized by small, folliculocentric papules with variable perifollicular erythema. The management of KP largely centers on moisturization and exfoliation.
- Moisturization: A study published in the Journal of drugs in dermatology 3 found that a moisturizing cream with 20% urea is effective in improving skin smoothness and texture in patients with KP.
- Exfoliation: Topical keratolytic agents, such as salicylic acid, are often used to exfoliate the skin and remove dead skin cells 4.
- Topical treatments: Other topical treatments, such as mineral oil-hydrophil petrolat, tacrolimus, azelaic acid, and salicylic acid, have also been shown to be effective in improving the appearance of KP 5.
- Laser therapy: Laser therapy, particularly the QS:Nd YAG laser, has been found to be an effective treatment for KP, especially for patients who are refractory to topical therapy 5, 6.
- Systemic treatments: In severe cases of KP, systemic treatments such as isotretinoin may be used 7.
Treatment Options
The choice of treatment for KP depends on the severity of the condition and the patient's response to treatment.
- General measures: General cutaneous measures, such as hydrating the skin, avoiding long baths or showers, and using mild soaps or cleansers, should be recommended to all patients with KP 4.
- Emerging treatments: New emerging treatments, such as microdermabrasion and laser therapy, are increasingly being used to treat KP 4, 6.