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

Prescription treatment alternatives to treat keratosis pilaris are topical retinoids, corticosteroids, urea, and topical immunomodulators. Topical prescription corticosteroids, e.g., triamcinolone 1% or desonide 0.05%, can be useful if over-the-counter solutions are found to be useless against inflammation. Prescription topical solutions should be applied 2 to 4 times a day as a thin layer that is spread onto the affected area. Like softer concentrations of hydrocortisone, caution should be used with the prescription medicines. Also, prescription-strength hydrocortisone can inhibit collagen synthesis and thereby lead to skin striate.

Concentrations of urea greater than 30% can be used to alleviate rough portions of the dermis. However, the urea concentration contained in the legend solutions is usually sensitizing and not a popular choice.

Topical retinoids used in the treatment of keratosis pilaris involve adapalene, tazarotene, and tretinoin. Their method of action can be to increase turnover of follicular epithelial cells. These agents should be applied as a thin layer to dry skin, at bedtime, to no more than 20% of the body's surface. The negative effects of redness, strong dryness, and peeling are in some instances 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 solutions.

Contact of the retinoid with the eyes and mouth should be eluded. Also avoid exposure to UV light. Like the AHAs, topical retinoids should be initially used every other day with a low-concentration solution and elevated to higher concentrations as tolerated. Burning and pruritus are usually seen in the first month and usually lessen with time. Topical retinoids are teratogenic and should not be employed by women of childbearing age. One solution's package insert suggests 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 therapies have been ineffective. 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 solutions should be applied twice daily to the affected 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 excessive 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 usually subside five to seven days after treatment. An advantage of the local immunomodulators is that their use is indicated for children 2 years of age and older.

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