Keratosis pilaris is a very common genetic follicular disorder manifested by the appearance of rough bumps on the skin and hence colloquially referred to as "chicken skin" or "goose bumps".

Prescription treatment options to treat keratosis pilaris are topical urea, corticosteroids, retinoids, and topical immunomodulators. Topical use corticosteroids, like triamcinolone 1% or desonide 0.05%, may be useful if over-the-counter products are found to be useless against inflammation. Prescription topical solutions should be used 2 to 4 times a day as a thin layer that is spread onto the afflicted area. Just as with softer concentrations of hydrocortisone, caution should be used with the prescription agents. Additionally, prescription-strength hydrocortisone may inhibit collagen synthesis and thereby lead to skin striate.

Concentrations of urea over 30% may be used to alleviate rough surfaces of the dermis. However, the urea proportion contained in the legend products is usually sensitizing and not a popular choice.

Topical retinoids used in the treatment of keratosis pilaris involve adapalene, tazarotene, and tretinoin. Their method of action may be to increase turnover of follicular epithelial cells. These agents should be used as a thin layer to dry skin, at bedtime, to no more than 20% of the skin's surface. The negative effects of redness, extreme dryness, and peeling are in some instances rate-limiting issues for most patients. However, some topical retinoids are available in reduced concentrations or in an emollient product base when compared to the original products.

Contact of the retinoid with the eyes and mouth should be avoided. Also avoid exposure to UV light. Like the AHAs, topical retinoids should be initially used every other day with a small-concentration product and increased to higher concentrations as tolerated. Burning and pruritus are commonly observed in the first four weeks and usually lessen with time. Topical retinoids are teratogenic and should not be used by women of childbearing age. One product's package insert recommends female patients should start therapy during a normal menstrual period. Prescribing information also states that children under the age of 12 should not use topical retinoids.

Topical immunomodulators, pimecrolimus, and tacrolimus may also be of benefit if other therapies have been inefficient. However, a public health advisory has been issued by the FDA about a potential risk of skin cancer with the use of topical immunomodulators for the therapy of eczema.

These products should be applied twice daily to the afflicted areas. If a moisturizer is also being used, the patient should be instructed to use the moisturizer after pimecrolimus. Patients should be cautioned to avoid exaggerated exposure to sunlight.

Patients may initially complain of a sensation of warmth or burning and skin irritation, specially during the first week of use. Most of these responses will usually subside five to seven days after therapy. An advantage of the topical immunomodulators is that their use is indicated for children 2 years of age and older.

Another advantage is that these elements do not impede collagen production and won't cause skin thinning. Occlusive dressings should be avoided with these agents. These agents should not be used in people with a compromised defensive system or during pregnancy since there are no adequate and well-controlled studies of topically used agents during pregnancy.

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