What is the treatment for keratosis pilaris (KP) or bumpy skin?

Treatment for Keratosis Pilaris (Bumpy Skin)

Start with topical urea 10% cream applied three times daily as first-line therapy for keratosis pilaris, as this is FDA-approved for this indication and recommended by major dermatology organizations. 1, 2

First-Line Topical Therapy

Keratolytic Agents

• Urea 10% cream three times daily is the primary recommended treatment for keratosis pilaris, serving both preventive and maintenance roles 1, 2
• Salicylic acid 6% is FDA-approved specifically for keratosis pilaris and works by removing excessive keratin from affected follicles 3
• Lactic acid-containing moisturizers can be used as an alternative keratolytic agent 4, 5

Basic Skin Care Measures

• Apply emollients regularly to combat the underlying skin dryness that exacerbates the condition 6, 5
• Avoid long baths or showers and use mild soaps or cleansers to prevent further drying 5
• Maintain consistent hydration of the skin as a foundational measure 5

Second-Line Therapy for Inflammatory Variants

Topical Corticosteroids

• High-potency topical steroids applied twice daily are indicated when there is significant perifollicular erythema or inflammation 1, 6
• These specifically target the inflammatory component rather than the keratotic papules themselves 1

Topical Retinoids

• Consider topical retinoids after keratolytic agents if initial therapy fails 5
• These work by normalizing follicular keratinization 5

Third-Line Options for Refractory Cases

Laser Therapy

• Fractional CO2 laser shows moderate to good improvement in 30% of patients at 12 weeks, particularly for keratotic papules and hyperpigmentation 7
• Q-switched Nd:YAG laser has the strongest evidence base among laser modalities for keratosis pilaris 8
• Laser therapy appears most effective for patients who fail topical treatments 5, 8
• Caution: Patients with Fitzpatrick skin type V may develop transient pigmentary changes and should be treated carefully 7

Microdermabrasion

• Can be considered as an alternative procedural option for refractory cases 5

Important Clinical Pitfalls

• Do not use systemic retinoids (such as acitretin) for typical keratosis pilaris—these are reserved only for severe congenital ichthyoses, not this condition 1
• Keratotic papules and hyperpigmentation respond better to treatment than the erythematous component 7
• The condition is chronic and requires ongoing maintenance therapy rather than curative treatment 6
• Patients should be counseled that this is primarily a cosmetic concern, though it can cause mild pruritus 6

Treatment Algorithm

1. Start: Urea 10% cream three times daily OR salicylic acid 6% topically 1, 3, 2
2. If inflammatory component present: Add high-potency topical steroid twice daily 1
3. If inadequate response after 12 weeks: Add topical retinoid 5
4. If refractory to all topicals: Consider laser therapy (Q-switched Nd:YAG or fractional CO2) 7, 8