Keratosis Follicularis (Darier Disease) Medication

Updated: Oct 01, 2020
  • Author: Pui-Yan Kwok, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
  • Print

Medication Summary

The goals of pharmacotherapy for keratosis follicularis (Darier disease) are to reduce morbidity and prevent complications.


Retinoid-like Agents

Class Summary

These agents decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. They also modulate keratinocyte differentiation.

Adapalene (Differin)

Adapalene modulates cellular differentiation, inflammation, and keratinization. It may be tolerated by individuals who cannot tolerate tretinoin creams. It is available as 0.1% gel or solution.

Tazarotene (Avage, Tazorac)

Tazarotene is a retinoid prodrug whose active metabolite modulates differentiation and proliferation of epithelial tissue; it may also have anti-inflammatory and immunomodulatory properties.

Tretinoin topical (Avita, Renova, Retin-A, Tretin X)

Tretinoin inhibits microcomedo formation and eliminates lesions present. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as 0.025, 0.05, and 0.1% creams or 0.01 and 0.025% gels.

Acitretin (Soriatane)

Acitretin is a metabolite of etretinate and is related to retinoic acid and retinol (vitamin A). The mechanism of action is unknown but it is thought to exert a therapeutic effect by modulating keratinocyte differentiation, hyperproliferation, and tissue infiltration by inflammatory cells. Its mechanism of action on keratosis follicularis (Darier disease) is unknown.

Isotretinoin (Amnesteem, Claravis, Sotret)

Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.