Medication Summary
The goals of pharmacotherapy for keratosis pilaris (KP) are to reduce morbidity and to prevent complications.
Retinoid-like Agents
Class Summary
Retinoic acid decreases cohesiveness of follicular epithelial cells, stimulates mitotic activity, and increases turnover of follicular epithelial cells.
Tretinoin topical (Retin-A, Avita, Retin A Micro)
Tretinoin inhibits microcomedo formation and eliminates the lesions present. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. Tretinoin topical is available as 0.025%, 0.05%, and 0.1% creams and 0.01%, 0.025%, 0.04%, and 0.1% gels.
Tazarotene (Tazorac)
This 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. It is available as 0.05% and 0.1% cream or gel. Tazarotene is a retinoid prodrug whose active metabolite modulates differentiation and proliferation of epithelial tissue; it may also have anti-inflammatory and immunomodulatory properties.
Adapalene (Differin)
Adapalene modulates cellular differentiation, inflammation, and keratinization. It may be tolerated by individuals who cannot tolerate tretinoin creams. A therapeutic response can be expected following 8-12 weeks of therapy. It is available as 0.1% gel or solution or 0.3% gel.
Topical Skin Products
Class Summary
Alpha hydroxy acid is a normal constituent of tissues and blood. Alpha hydroxy acids act as humectants when applied topically and may decrease corneocyte cohesion.
Topically applied urea has a hygroscopic effect by increasing the water retention in skin and it decreases pruritus.
Urea (Carmol, Aluvea, Keralac, Kerol, Remeven)
Urea promotes hydration and removal of excess keratin in conditions of hyperkeratosis. It is available in 10-40% concentrations.
Ammonium lactate lotion (AmLactin, Lac-Hydrin, Geri-Hydrolac)
Ammonium lactate lotion is indicated for ichthyosis vulgaris and xerosis. It contains lactic acid, an alpha-hydroxy acid that has keratolytic action, thus facilitating the release of comedones. It causes disadhesion of corneocytes. Use 12% cream or lotion.
Corticosteroids
Class Summary
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Fluticasone (Cutivate)
Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activities. It has a weak inhibitory affect on the HPA axis when applied topically.
-
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.
