Topical Treatments for Keratosis Pilaris

What Is Keratosis Pilaris?

Keratosis pilaris is a skin condition characterized by the appearance of follicular hyperkeratotic, erythematous papules most frequently seen on the extensor surfaces of the proximal extremities.1 It can also less commonly affect the trunk, distal extremities, and lateral cheeks.1 It affects 50 to 80 percent of adolescents and approximately 40 percent of the adult population.1

Although it is commonly seen, its exact etiology and pathophysiology are unknown. It is thought that keratosis pilaris may be a result of a loss of normal epithelial barrier function, as supported by the condition’s association with atopic dermatitis and mutations in the filaggrin gene.1 Furthermore, the most widely accepted theory of its pathophysiology proposes that abnormal follicular epithelial keratinization causes an infundibular plug to form, leading to erythema and scaling around the follicle opening.1

Keratosis pilaris is asymptomatic and often improves over time, but treatment may be pursued to improve the skin’s cosmetic appearance and alleviate psychological distress.1 The condition has no known cure, and is often difficult to treat due to the limited efficacy of currently available therapies.1 The most widely available existing topical treatments include emollients, keratolytic agents, and retinoids.2

What Is Used to Treat Keratosis Pilaris?

The most commonly used interventions to treat keratosis pilaris are:

  • Keratolytic agents
  • Emollients
  • Topical retinoids
  • Laser therapy

Keratolytic Agents

Topical keratolytic agents are among the first line treatments for keratosis pilaris.1 These agents facilitate the breakdown and desquamation of keratinized cells in the stratum corneum and can improve the skin’s texture.3 Keratolytics include compounds such as salicylic acid, lactic acid, urea, alpha hydroxy acid, beta hydroxy acid, and propylene glycol.2

A randomized clinical study compared the efficacy, safety, hydrating properties, and tolerability of lactic acid and salicylic acid topical creams in the treatment of keratosis pilaris.3 Patients applied either 10% lactic acid or 5% salicylic acid creams twice daily for 3 months.3 Both treatments showed a significant reduction of lesions at the end of 4, 8, and 12 weeks of treatment, with a mean percentage of reduction from baseline of 66% in the lactic acid group and 52% in the salicylic acid group.3 Mild irritation of the skin with a burning or itching sensation was the only adverse side effect reported in the study, and it was seen more frequently in the lactic acid group.3 Skin conductance also became significantly higher after treatment with both agents, reflecting an improved state of hydration of the skin’s surface.3 The study concluded that 10% lactic acid cream improves skin texture by stimulating cell growth towards the skin surface and providing outer skin hydration at a slower pace, while 5% salicylic acid cream improves hydration by directly removing the upper surface layer of dead cells, softening the skin.3

Emollients

Often used in conjunction with keratolytics, emollients are an additional first line treatment for keratosis pilaris.1 They include creams, ointments, and moisturizers, and help to maintain hydration of the skin while reducing flaking.4 The American Academy of Dermatology recommends that patients with keratosis pilaris apply moisturizer after every shower or bath, within 5 minutes of getting out of the bath or shower while the skin is still damp, and at least 2 or 3 times a day.2 Many of the moisturizing creams used to treat keratosis pilaris contain urea or lactic acid.2 Furthermore, a study of 30 patients demonstrated the efficacy of Aquaphor ointment in improving the appearance of keratosis pilaris in pediatric patients.5 Aquaphor is an inexpensive topical emollient and was shown to improve the clinical findings of keratosis pilaris in 78% of patients after 4 weeks of use.5

Topical Retinoids

Topical retinoids, such as tazarotene, selectively transactivate the retinoic acid receptors of the skin.6 This mechanism modulates keratinocyte differentiation through an antiproliferative effect.6 Topical retinoids can thus have a role in controlling the hyperkeratotic lesions seen in keratosis pilaris. A 2002 study demonstrated the efficacy of topical retinoids in reducing or resolving the lesions of keratosis pilaris.6 20 patients with keratosis pilaris applied an oil-in-water emulsion containing 0.01% tazarotene daily for 4 to 8 weeks.6 The lesions began to gradually fade in 2 weeks, and resolved after 4 to 8 weeks.6 Topical retinoids are typically a second line treatment used if a patient has had no response to a trial of treatment with emollients and topical keratolytics.1

Laser Therapy

Laser therapy has also been shown to have efficacy in improving the cosmetic appearance of keratosis pilaris in patients with lesions refractory to treatment with other topical methods.1 Types of lasers that may be used include pulsed dye laser, alexandrite laser, Nd:YAG laser, and fractional CO2 laser treatments.1 Laser therapy has been shown to be effective in decreasing skin hyperpigmentation and roughness and is easily accessible and safe.7

Summary Table: Topical Treatments of Keratosis Pilaris

Treatment

Mechanism of Action

Examples

Notes

Keratolytic Agents

Facilitate breakdown and desquamation of cells in the stratum corneum3

  • Salicylic acid
  • Lactic acid
  • Urea
  • Alpha/beta hydroxy acid
  • Propylene glycol
  • When applied for 4, 8, and 12 weeks, lactic acid and salicylic acid were shown to have a mean reduction in appearance of lesions of 66% and 52%, respectively3

Emollients

Maintain hydration of the skin while reducing flaking4

  • Creams
  • Ointments
  • Moisturizers

The American Academy of Dermatology recommends that patients with KP apply moisturizer:

  • After every shower or bath
  • Within 5 minutes of getting out of the bath or shower while the skin is still damp
  • At least 2 or 3 times a day2

Topical Retinoids

Selectively transactivate the retinoic acid receptors of the skin6

Modulate keratinocyte differentiation through an antiproliferative effect6

  • Tazarotene
  • When applied daily for 4 to 8 weeks, topical retinoids have been shown to fade and resolve the appearance of lesions6

Laser Therapy

Decrease skin hyperpigmentation and roughness7

  • Pulsed dye laser
  • Alexandrite laser
  • Nd:YAG laser
  • Fractional CO2 laser
  • Can be efficacious in treating lesions refractory to treatment with other topical methods

Practical Tips

  • Although keratosis pilaris is asymptomatic, the cosmetic appearance of lesions can result in psychological distress in affected patients
  • Keratosis pilaris is often refractory to treatment, but topical retinoids, keratolytic agents, emollients, and laser therapy have been shown to improve clinical findings in some patients
  • In many cases, keratosis pilaris will resolve on its own over time
* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Pennycook KB, McCready TA. Keratosis Pilaris. In: StatPearls. StatPearls Publishing; 2020. Accessed July 19, 2020. http://www.ncbi.nlm.nih.gov/books/NBK546708/
  2. Keratosis pilaris: Diagnosis and treatment. Accessed July 19, 2020. https://www.aad.org/public/diseases/a-z/keratosis-pilaris-treatment
  3. Kootiratrakarn T, Kampirapap K, Chunhasewee C. Epidermal Permeability Barrier in the Treatment of Keratosis Pilaris. Dermatol Res Pract. 2015;2015. doi:10.1155/2015/205012
  4. Purnamawati S, Indrastuti N, Danarti R, Saefudin T. The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review. Clin Med Res. 2017;15(3-4):75-87. doi:10.3121/cmr.2017.1363
  5. A Comparative Trial Comparing the Efficacy of Tacrolimus 0.1% Ointment with Aquaphor Ointment for the Treatment of Keratosis Pilaris - BREITHAUPT - 2011 - Pediatric Dermatology - Wiley Online Library. Accessed July 19, 2020. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1525-1470.2011.01497.x
  6. Gerbig AW. Treating keratosis pilaris. J Am Acad Dermatol. 2002;47(3):457. doi:10.1067/mjd.2002.122733
  7. Schoch JJ, Tollefson MM, Witman P, Davis DMR. Successful Treatment of Keratosis Pilaris Rubra with Pulsed Dye Laser. Pediatr Dermatol. 2016;33(4):443-446. doi:10.1111/pde.12892
 
 
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