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. Clinical Pharmacology 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.
Keratosis Pilaris treatment with urea (TOP) is indicated, as it is useful for the treatment of hyperkeratotic conditions, including keratosis pilaris. The mechanism of action involves loosening of the horny layer of the skin and shedding of scaly skin, which helps to soften hyperkeratotic areas of the skin 1 1.
- Key benefits: softening of hyperkeratotic areas, loosening of the horny layer of the skin, and shedding of scaly skin.
From the Research
Keratosis pilaris can be effectively treated with a 20% urea cream, as it has been shown to significantly improve skin smoothness and texture with minimal adverse events 2. The treatment of keratosis pilaris typically involves a combination of gentle exfoliation and intensive moisturizing.
- Start with a keratolytic moisturizer containing urea (10-20%), lactic acid, or salicylic acid applied daily to affected areas after showering.
- AmLactin lotion (12% lactic acid) or CeraVe SA Cream (with salicylic acid) are excellent options used once or twice daily.
- For more stubborn cases, consider adding a gentle chemical exfoliant like glycolic acid (5-10%) or a retinoid cream (adapalene 0.1% or tretinoin 0.025%) a few times weekly. Keep showers lukewarm and brief, as hot water worsens the condition.
- Use fragrance-free, gentle cleansers rather than harsh soaps. Consistency is crucial—improvement typically takes 4-6 weeks of regular treatment. These treatments work by dissolving the keratin plugs that cause the characteristic "chicken skin" bumps while hydrating the skin barrier. Prescription retinoids or stronger acid formulations may be needed for severe cases, but most respond well to over-the-counter options with consistent use. Remember that keratosis pilaris often improves in summer and worsens in winter due to humidity changes, so you may need to adjust treatment seasonally 3, 4, 5. However, the most recent and highest quality study suggests that a 20% urea cream is a well-tolerated and effective treatment option for keratosis pilaris, with significant improvements in skin smoothness and texture after 4 weeks of use 2.