Keratosis Pilaris Medication

  • Author: Nili N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 23, 2012
 

Medication Summary

The goals of pharmacotherapy for keratosis pilaris (KP) are to reduce morbidity and to prevent complications.

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Retinoids

Class Summary

Retinoic acid decreases cohesiveness of follicular epithelial cells, stimulates mitotic activity, and increases turnover of follicular epithelial cells.

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Tretinoin topical (Retin-A, Avita, Retin A Micro)

 

Inhibits microcomedo formation and eliminates lesions present. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Available also as 0.01%, 0.025%, 0.04%, and 0.1% gels.

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Alpha-hydroxy acids

Class Summary

Normal constituent of tissues and blood. Act as humectants when applied topically and may decrease corneocyte cohesion.

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Ammonium lactate lotion (AmLactin, Lac-Hydrin)

 

Indicated for treatment of ichthyosis vulgaris and xerosis. Contains lactic acid, an alpha-hydroxy acid that has keratolytic action, thus facilitating release of comedones. Causes disadhesion of corneocytes. Use 12% cream or lotion.

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Topical skin products

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Urea

 

Promotes hydration and removal of excess keratin in conditions of hyperkeratosis.

Available in 10-40% concentrations.

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Hydroquinone and tretinoin (Solage)

 

Mequinol (hydroquinone) is a depigmenting agent theorized to cause cytotoxic products in melanocytes or inhibit melanin formation. Tretinoin is a retinoid, which also elicits depigmenting effect. Available as a topical solution combination product containing mequinol 2% and tretinoin 0.01%.

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Keratolytic agents

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Tazarotene (Tazorac)

 

Receptor-selective retinoid is a synthetic retinoid prodrug that is rapidly converted into tazarotenic acid. Because use of tretinoin often is hampered by its irritancy, this product may be advantageous. Available as 0.05% and 0.1% cream or gel.

Retinoid prodrug whose active metabolite modulates differentiation and proliferation of epithelial tissue; may also have anti-inflammatory and immunomodulatory properties.

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Adapalene (Differin)

 

Modulates cellular differentiation, inflammation, and keratinization. May be tolerated by individuals who cannot tolerate tretinoin creams. A therapeutic response can be expected following 8-12 wk of therapy. Available as 0.1% gel or solution or 0.3% gel.

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Corticosteroids, topical (medium potency)

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Fluticasone (Cutivate)

 

Extremely potent vasoconstrictive and anti-inflammatory activities. Has weak inhibitory affect on HPA axis when applied topically.

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Contributor Information and Disclosures
Author

Nili N Alai, MD, FAAD  Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California

Nili N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

We authors appreciate the clinical photos supplied as a courtesy of The Skin Center at Laguna.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Dena Thompson, MS, and Arash Michael Saemi, MD, to the development and writing of this article.

References

  1. Hwang S, Schwartz RA. Keratosis pilaris: a common follicular hyperkeratosis. Cutis. Sep 2008;82(3):177-80. [Medline].

  2. Sardana K, Relhan V, Garg V, Khurana N. An observational analysis of erythromelanosis follicularis faciei et colli. Clin Exp Dermatol. May 2008;33(3):333-6. [Medline].

  3. Augustine M, Jayaseelan E. Erythromelanosis follicularis faciei et colli: relationship with keratosis pilaris. Indian J Dermatol Venereol Leprol. Jan-Feb 2008;74(1):47-9. [Medline].

  4. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. Jun 2007;56(6):901-16; quiz 917-20. [Medline].

  5. Poskitt L, Wilkinson JD. Natural history of keratosis pilaris. Br J Dermatol. Jun 1994;130(6):711-3. [Medline].

  6. Arnold AW, Buechner SA. [Keratosis pilaris and keratosis pilaris atrophicans faciei]. J Dtsch Dermatol Ges. Apr 2006;4(4):319-23. [Medline].

  7. Mevorah B, Marazzi A, Frenk E. The prevalence of accentuated palmoplantar markings and keratosis pilaris in atopic dermatitis, autosomal dominant ichthyosis and control dermatological patients. Br J Dermatol. Jun 1985;112(6):679-85. [Medline].

  8. Jackson JB, Touma SC, Norton AB. Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?. W V Med J. Jan-Feb 2004;100(1):26-8. [Medline].

  9. Kragballe K, Steijlen PM, Ibsen HH, et al. Efficacy, tolerability, and safety of calcipotriol ointment in disorders of keratinization. Results of a randomized, double-blind, vehicle-controlled, right/left comparative study. Arch Dermatol. May 1995;131(5):556-60. [Medline].

  10. Use of Lasers for Becker's Nevus and Keratosis Pilaris. J Cutan Aesthet Surg. Jul 2008;1(2):112. [Medline].

  11. Kaune KM, Haas E, Emmert S, Schon MP, Zutt M. Successful treatment of severe keratosis pilaris rubra with a 595-nm pulsed dye laser. Dermatol Surg. Oct 2009;35(10):1592-5. [Medline].

  12. Clark SM, Mills CM, Lanigan SW. Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser. J Cutan Laser Ther. Sep 2000;2(3):151-6. [Medline].

  13. Novick NL. Practical management of widespread, atypical keratosis pilaris. J Am Acad Dermatol. Aug 1984;11(2 Pt 1):305-6. [Medline].

 
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Close-up view of keratosis pilaris. Keratotic follicular-based erythematous papules are noted on upper arm.
Keratosis pilaris in characteristic location on outer upper arm of a 30-year-old woman.
Classic skin-colored bumps on upper arm of young white female twin. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on the upper arm of a twin female. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris bumps on arm of a white female twin. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on upper arm. Image courtesy of The Skin Center of Laguna.
Keratosis pilaris on upper arm of twin. Image courtesy of The Skin Center of Laguna.
 
 
 
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