eMedicine Specialties > Pediatrics: General Medicine > Dermatology
Keratosis Pilaris: Treatment & Medication
Updated: Oct 12, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Education and reassurance are the cornerstones of therapy for keratosis pilaris.5
- The noninflamed horny papules usually remit with age and increasing time, but they are resistant to most forms of short-term therapy.
- Encourage tepid showers instead of hot baths, along with the use of mild soaps and a home humidifier.
- An emollient cream may help alleviate rough surfaces in mild cases. A topical keratolytic agent such as lactic acid, salicylic acid, or urea preparations may be beneficial in more extensive cases. Several recent reports claim good results with 2-3% salicylic acid in 20% urea cream. Topical tretinoin therapy has also been used with varying degrees of success.
- Lesions with significant inflammation may improve with the use of medium-potency emollient-based topical steroid preparations. Inflammation is usually reduced markedly by 7 days, at which point the steroid should be discontinued.
Medication
Alpha hydroxy acids
Alpha hydroxy acid is a normal constituent of tissues and blood. Acids act as humectants when applied topically and may decrease corneocyte cohesion.
Ammonium lactate cream (Lac-Hydrin cream 12%)
Emollient available in 225-g and 400-g bottles and promotes hydration and removal of excess keratin. Contains lactic acid, an alpha hydroxy acid that has keratolytic action, thus facilitating release of comedones.
Adult
Apply to affected area bid/tid
Application to the skin while moist after washing or bathing enhances the moisturizing effect
Pediatric
Apply as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Apply hydration, moisturizers, and possibly topical corticosteroids until fissures and inflammation are reduced; transient stinging, burning, erythema, and peeling have been noted after application of ammonium lactate lotion, especially when applied to abraded, inflamed, or irritated skin
Emollients containing urea
Topically applied urea has a hygroscopic effect by increasing the water retention in skin and it decreases pruritus.
Urea cream 20% (Carmol 20, Ureacin, Lanaphilic)
Application of 20% urea promotes hydration and removal of excess keratin.
Adult
Apply to affected area bid/tid
Application to the skin while moist after washing or bathing enhances the moisturizing effect
Pediatric
Apply as in adults
None reported with topical use
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Apply hydration, moisturizers, and possibly topical corticosteroids until fissures and inflammation are reduced; transient stinging, burning, erythema, and peeling have been noted after application of 20% urea, especially when applied to abraded, inflamed, or irritated skin
Gels containing salicylic acid
These agents produce desquamation of the skin's horny layer. They are keratolytic at concentrations of 2-6%.
Salicylic acid 6% (Keralyt gel)
Removes excess keratin.
Adult
Apply a thin layer to affected area qd/bid
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; prolonged use in infants, patients with diabetes mellitus, and patients with impaired circulation (not recommended); use on moles, birthmarks or warts with hair growing from them, genital or facial warts or warts on mucous membranes, irritated skin, or any area infected or reddened
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Burning and irritation at site of exposure may occur; avoid contact with mucous membranes and eyes; prolonged use over large areas, especially in children, may result in salicylate toxicity
Retinoids
Retinoic acid decreases cohesiveness of follicular epithelial cells, stimulates mitotic activity, and increases turnover of follicular epithelial cells.
Tretinoin (Retin-A 0.025% - 0.1% cream)
Reduces cohesion among keratinized cells.
Adult
Begin with lowest tretinoin concentration and increase as tolerated; apply hs or qod; decrease application frequency if irritation develops
Pediatric
Apply as in adults
Toxicity increases with coadministration of benzoyl peroxide, salicylic acid, and resorcinol; avoid topical sulfur, resorcinol, salicylic acid, other keratolytics, abrasives, astringents, spices, and lime
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with excessive sunlight exposure, wear sunscreen over exposed areas; during the first few wk, the patient may experience redness, burning, or peeling; most patients adapt to treatment; switch those who become excessively irritated to qod or q3d therapy; do not apply to mucous membranes, mouth, and angles of nose
Topical corticosteroids
These agents elicit anti-inflammatory and immunosuppressive properties.
Triamcinolone acetonide 0.1% cream (Aristocort, Kenalog)
A moderate-potency steroid with anti-inflammatory properties. It treats inflammatory dermatosis that is responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult
Apply sparingly to affected areas qd/bid until inflammatory component begins to resolve (typically 7 d)
Pediatric
Apply as in adults with caution
None reported
Documented hypersensitivity; fungal, viral, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
As with all topical corticosteroids, skin atrophy with telangiectasia, stria, purpura, and acne may occur; limit the use of topical steroids to the initial inflammatory treatment phase; long-term use of topical corticosteroids has no role in keratosis pilaris; limit tube size to reflect area and duration of treatment; do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria
More on Keratosis Pilaris |
| Overview: Keratosis Pilaris |
| Differential Diagnoses & Workup: Keratosis Pilaris |
 Treatment & Medication: Keratosis Pilaris |
| Follow-up: Keratosis Pilaris |
| Multimedia: Keratosis Pilaris |
| References |
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References
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Further Reading
Keywords
keratosis pilaris alba, keratosis pilaris rubra, goose bumps, hair follicle, keratinized hair follicles, keratotic papule, perifollicular erythema, ichthyosis vulgaris, atopic dermatitis, hyperandrogenism, erythematous papules, corneocyte adhesion, hyperkeratosis, hypogranulosis
