Keratosis pilaris is a very common genetic follicular disorder manifested by the presence of coarse bumps on the skin, more commonly known as "chicken skin" or "goose bumps".

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

Concentrations of urea over 30% can be used to alleviate rough portions of the dermis. However, the urea proportion contained in the legend products is commonly sensitizing and not a popular alternative.

Topical retinoids used in the treatment of keratosis pilaris include adapalene, tazarotene, and tretinoin. Their method of action can be to elevate 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 body's surface. The negative effects of redness, extreme dryness, and peeling are in some cases rate-limiting effects for most patients. However, some topical retinoids are available in reduced concentrations or in an emollient cream base when compared to the original products.

Contact of the retinoid with the eyes and mouth should be eluded. Also avoid exposure to UV light. Just like the AHAs, topical retinoids should be initially used every other day with a low-concentration product and increased to higher concentrations as tolerated. Burning and pruritus are usually observed in the first month and commonly lessen with time. Topical retinoids are teratogenic and should not be employed 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 can also be of benefit if other treatments have been inefficient. However, a public health advisory has been issued by the FDA about a potential risk of skin cancer with the application of topical immunomodulators for the treatment 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 can initially complain of a feeling of warmth or burning and skin irritation, specially during the first few days of use. Most of these reactions will commonly subside five to seven days after treatment. An advantage of the topical immunomodulators is that their use is approved for children 2 years of age and older.

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