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

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

Concentrations of urea over 30% may 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 applied in the treatment of keratosis pilaris involve adapalene, tazarotene, and tretinoin. Their method of action may 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 adverse effects of redness, strong dryness, and peeling are in some instances rate-limiting effects for most patients. However, some topical retinoids are available in minimal concentrations or in an emollient product base when compared to the original solutions.

Contact of the retinoid with the eyes and mouth should be eluded. Also avoid exposure to ultraviolet light. Like the AHAs, topical retinoids should be initially applied every other day with a low-concentration product and elevated to higher concentrations as tolerated. Burning and pruritus are commonly seen in the first four weeks and usually lessen with time. Topical retinoids are teratogenic and should not be used by women of childbearing age. One product's package insert recommends female patients should begin treatment 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 may also be of benefit if other therapies have been ineffective. However, a public health warning has been issued by the FDA about a potential danger of skin cancer with the use of topical immunomodulators for the treatment of eczema.

These solutions should be applied twice daily to the afflicted areas. If a moisturizer is also being applied, the patient should be instructed to apply the moisturizer after pimecrolimus. Patients should be cautioned to avoid exaggerated exposure to sunlight.

Patients may initially complain of a feeling of warmth or burning and skin irritation, especially during the first week of use. Most of these reactions will usually 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 agents do not inhibit collagen production and will not 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 researches of topically used agents in pregnancy.