Indications for Urea Powder
Urea powder is primarily indicated for treating hyperkeratotic skin conditions including ichthyosis, xerosis, psoriasis, and hand-foot skin reactions from anticancer therapies, with concentrations ranging from 5-40% depending on the condition and location. 1
Primary Indications
Ichthyosis and Hyperkeratotic Conditions
- Congenital ichthyoses: Urea is the most frequently used keratolytic agent for reducing scales and hyperkeratosis 1
- Concentrations: 10-20%, up to 40% for localized areas of thick scale
- Application: Once or twice daily, can be tapered based on response
- Evidence shows superiority over simple emollients for scale removal
Dermatitis Management
- Xerosis/Dry skin: Urea 5-10% is effective for general dry skin conditions 2, 3
- Atopic dermatitis: Used as a moisturizing agent to improve skin barrier function 4
- Seborrheic dermatitis: Helps with scaling and dryness 4
Anticancer Treatment-Related Skin Reactions
- Hand-foot skin reaction (HFSR) and Palmar-plantar erythrodysesthesia syndrome (PPES) 1
- Preventive use: Urea 10% cream three times daily
- Treatment of established reactions: Urea 10-40% as keratolytic agent
Other Dermatological Conditions
- Psoriasis: Combination of sodium chloride and urea in equal concentrations is optimal 5
- Onychomycosis: As adjunctive therapy 6
- Keratosis: For keratolytic effects 6
Concentration Guidelines
| Condition | Concentration | Application Frequency |
|---|---|---|
| General dry skin/Xerosis | 5-10% | 1-2 times daily |
| Ichthyosis (general) | 10-20% | 1-2 times daily |
| Localized thick scales | Up to 40% | 1-2 times daily |
| HFSR/PPES prevention | 10% | 3 times daily |
| HFSR/PPES treatment | 10-40% | As needed |
Application Considerations
Age-Related Considerations
- Children under 1 year: Not recommended except on limited areas like palms and soles 1
- Children 1-2 years: Restrict to once daily application on limited areas 1
- Adults: Can be used more liberally as needed
Anatomical Considerations
Potential Side Effects
- Stinging and burning sensation (more common at higher concentrations)
- Irritation (particularly on sensitive or damaged skin)
- Generally well-tolerated at lower concentrations (5-10%) 3
Clinical Pearls
- Urea works through multiple mechanisms: moisturizing, keratolytic, and improving skin barrier function 4
- Most effective when applied after bathing to improve skin hydration 1
- Can be used as a penetration enhancer for other topical medications 6
- For hyperkeratotic conditions, consistent application is necessary for optimal results
- Urea is particularly valuable as it addresses both dryness and scaling simultaneously
Urea powder formulations should be compounded into appropriate vehicles (creams, ointments) based on the specific indication and patient needs, with concentration adjusted according to the severity of the condition.