Can Ammonium Lactate Be Used for Itchy Skin?
Yes, ammonium lactate is FDA-approved and specifically indicated for temporary relief of itching associated with dry, scaly skin (xerosis) and ichthyosis vulgaris. 1
Primary Indication and Mechanism
Ammonium lactate lotion is formally indicated by the FDA for treating dry, scaly skin (xerosis) and ichthyosis vulgaris, with explicit approval for temporary relief of itching associated with these conditions. 1 This makes it a legitimate first-line option when pruritus is directly related to xerotic (dry) skin conditions.
Clinical Context for Use
Ammonium lactate works best for itch that stems from skin dryness and scaling, not for all types of pruritus. The evidence supports its use in specific scenarios:
When to Use Ammonium Lactate:
- Xerosis-associated pruritus: The primary FDA-approved indication where dry skin is the underlying cause of itching 1
- Ichthyosis vulgaris with itching: Demonstrated effectiveness in congenital ichthyoses where keratolytics like ammonium lactate (along with urea and alpha-hydroxyacids) show superiority over simple emollients in removing scales 2
- Atopic dermatitis with xerosis: A randomized, double-blind study showed that liquid soap containing 12% ammonium lactate + 20% urea significantly improved itch (P < 0.001) in patients with mild-to-moderate atopic dermatitis 3
Comparative Effectiveness:
Ammonium lactate 12% lotion performs equivalently to 5% salicylic acid + 10% urea ointment for treating foot xerosis, with both showing significant improvement after 2-4 weeks of treatment. 4 However, lactic acid 10% with strontium causes significantly less burning/stinging than ammonium lactate 12% (P<0.0001), which is an important consideration for patient tolerability. 5
Important Limitations and Caveats
Ammonium lactate is NOT appropriate for all types of pruritus. The guidelines make clear distinctions:
- For generalized pruritus without xerosis, other approaches are preferred: skin moisturizers with urea- or polidocanol-containing lotions, or systemic H1-antihistamines (cetirizine, loratadine, fexofenadine) for grade 2/3 pruritus 2
- For inflammatory pruritus (eczema, dermatitis), topical corticosteroids are the mainstay, not keratolytics alone 2
- Avoid application on face, flexures, and areas of fissuring as keratolytics may induce irritation 2
- Side effects include itching, burning sensation, and irritation in some patients 2
Practical Application Algorithm
Identify the cause of itch: Is it associated with dry, scaly skin (xerosis) or ichthyosis? If yes, proceed with ammonium lactate 1
Apply ammonium lactate 12% lotion: Use once or twice daily, ideally after bathing to improve skin hydration 2
Combine with emollients: Apply emollients at least twice daily, as often as necessary, to maintain skin hydration 2
Monitor for irritation: If burning/stinging occurs, consider switching to lactic acid 10% with strontium as a better-tolerated alternative 5
If inadequate response after 2-4 weeks: Consider adding topical corticosteroids for any inflammatory component, or reassess the underlying cause of pruritus 2
Additional Benefit
Ammonium lactate 12% has the unique property of mitigating cutaneous atrophy caused by potent topical corticosteroids, producing significant sparing of both epidermal and dermal atrophy without affecting the corticosteroid's anti-inflammatory properties. 6 This makes it particularly useful when combining treatments for inflammatory skin conditions with xerosis.