Is urea effective in treating psoriasis?

Does Urea Help Psoriasis?

Yes, urea is an effective adjunctive treatment for psoriasis, particularly as a keratolytic agent to reduce scaling and hyperkeratosis when used at concentrations of 10% or higher. 1, 2, 3

Role of Urea in Psoriasis Management

Urea functions as both a keratolytic and emollient agent in psoriasis treatment, though it is not considered a primary therapeutic agent but rather an important adjunctive therapy. 2, 3

Efficacy Evidence

• A prospective observational study demonstrated that daily application of an emollient containing 10% urea (with ceramides, glycerin, and glyceryl glucoside) for 4 weeks resulted in significant improvement in both quality of life (DLQI) and clinical outcomes (local PASI) in patients with mild to moderate psoriasis who were stable on their baseline antipsoriatic therapy. 1

• Urea at concentrations ≥10% has superior efficacy compared to simple emollients alone for removing scales and hyperkeratosis in psoriasis. 4

• Clinical experience supports using urea concentrations up to 20% for general psoriatic plaques, and even up to 40% for localized areas of thick scale or hyperkeratosis (such as palmoplantar regions). 4

• Low-concentration urea (5-10%) provides relief from itching and is effective for dry skin associated with psoriasis, though higher concentrations are needed for significant keratolytic effects. 5, 6

Practical Application Guidelines

Concentration Selection

• Use 10-20% urea for standard psoriatic plaques with scaling and hyperkeratosis. 4, 1

• Increase to 40% urea for localized areas of thick scale, such as elbows, knees, or palmoplantar psoriasis. 4

• Use 5-10% urea for maintenance therapy or when treating large body surface areas to minimize irritation. 5, 6

Application Protocol

• Apply once or twice daily depending on severity and tolerance. 4

• Taper frequency based on clinical response as scaling improves. 4

• Apply after bathing to improve skin hydration and penetration. 4

Areas to Avoid

• Do not apply to the face, flexures, or areas with fissuring, as urea may induce significant irritation in these sensitive locations. 4

• Avoid application on inflamed or actively infected skin. 5

Safety Considerations

Common Side Effects

• Itching, burning sensation, and irritation are the most common adverse effects, particularly at higher concentrations. 4, 2

• These side effects are typically mild, transient, and non-systemic. 2, 3, 6

• At low concentrations (5-10%), stinging and burning are rare. 6

Age-Related Precautions

• Urea is contraindicated in the neonatal period due to risk of systemic absorption through the immature epidermal barrier. 4

• Strictly avoid urea in children under 2 years of age, except for very limited application once daily on specific areas like palms and soles. 4

• High blood urea concentrations have been reported after cutaneous application of 10% urea (plus 5% lactic acid) in collodion babies and infants with lamellar ichthyosis. 4

Integration with Other Psoriasis Therapies

Combination with Standard Treatments

• Urea serves as an effective adjunct to topical corticosteroids, vitamin D analogues, and systemic therapies by improving penetration and optimizing drug action. 1, 2, 3

• The American Academy of Dermatology recommends applying emollients (including urea-containing products) in conjunction with topical corticosteroids for 4-8 weeks to reduce itching, scaling, and body surface area involvement. 7

• Continue baseline antipsoriatic therapy (topical, systemic, or phototherapy) while adding urea as adjunctive treatment. 1

Timing Considerations

• Apply emollients containing urea after calcipotriene/corticosteroid combination products to avoid washing off active medication. 7

• For optimal keratolytic effect, apply urea-containing products consistently as part of a daily skincare regimen. 1, 6

Clinical Context and Limitations

While urea demonstrates clear benefit for managing the scaling and hyperkeratosis associated with psoriasis, it does not address the underlying inflammatory pathology of the disease. 2, 3 Therefore, urea should be viewed as a supportive therapy that enhances the effectiveness of anti-inflammatory treatments rather than as monotherapy for active psoriasis. 1

The evidence supporting urea in psoriasis is primarily from observational studies and clinical experience rather than large randomized controlled trials specifically designed for psoriasis. 1, 2, 5 However, its long history of safe use, minimal side effects, and demonstrated clinical benefit in reducing scaling justify its routine incorporation into psoriasis management regimens. 2, 3, 6