Keratosis pilaris (KP) is a common condition characterized by keratotic, follicular papules with varying degrees of surrounding erythema. It most often affects the lateral face, extensor arms, and thighs and is prevalent in children. Although KP can improve by late adolescence, it persists into adult life in at least one-third of patients. Patients (or their parents) should be counseled about the benign nature of KP, and expectations should be tempered as treatment may minimize the symptoms temporarily but does not eradicate the condition. In the author’s experience, simple measures such as avoiding drying or irritating skin care products and the frequent use of bland emollients are reasonable first steps, especially in young children. Patient age, motivation, and tolerance of adverse effects are factors to consider when choosing therapy. Keratolytics are usually initiated if emollients are not sufficient. Cost and inconsistency and/or impermanence of outcomes limit the utility of procedural interventions for KP. Studies of treatments for KP tend to be limited by low numbers of patients, combinations of several treatments, and heterogenous assessment of outcomes, making the overall quality of evidence low to moderate.1 See Table 35-1.
Table 35-1Keratosis Pilaris Treatment Table ||Download (.pdf) Table 35-1 Keratosis Pilaris Treatment Table
|MEDICATION NAME ||INDICATION ||MECHANISM OF ACTION ||DOSING ||ADVERSE EFFECTS ||SUGGESTED MONITORING ||LEVEL OF EVIDENCE (REFERENCE) |
|Topical Therapy |
|Emollients ||Dryness, roughness ||Occlusive ||BID PRN ||Irritation (depending on formulation) ||None ||IV |
|Ammonium lactate, glycolic acid, lactic acid, salicylic acid ||Roughness ||Keratolytic ||BID ||Burning, stinging, irritation ||None ||IB,2 IV |
|Urea ||Roughness ||Humectant, keratolytic ||BID ||Burning, stinging, irritation ||None ||IV |
|Retinoids (eg, retinol 0.25%-1%, tretinoin 0.025%-0.1%, tazarotene 0.05%-0.1%) ||Roughness || ||Daily ||Dryness, irritation ||None ||IB,3 IV |
|Corticosteroid (low potency) ||Erythema, irritation, itching ||Anti-inflammatory ||BID ||Folliculitis ||None ||IV |
|Calcineurin inhibitors (eg, pimecrolimus 1%, tacrolimus 0.03%-0.1%) ||Erythema, irritation, itching ||Anti-inflammatory ||BID ||Burning, stinging ||None ||IB,4 IV |
|Procedural Therapy |
|Fractionated CO2 laser (10,600 nm) ||Hyperpigmentation, roughness ||Ablation of keratotic papule ||Settings depend on device; goal ablation depth of 530-580 μm ||Erythema, dyspigmentation ||None ||IB5-7 |
|Diode laser (810 nm) ||Roughness ||Ablation of vellus hairs ||Fluence: 45-60 J/cm2; pulse duration 30-100 msec ||Hyperpigmentation ||None ||IB8 |
|q-switched Nd-Yag; Nd-Yag (1064 nm) ||Dyspigmentation, erythema, roughness ||Ablation of hair follicle, melanin, superficial vessels ||4-6 J/cm2; 4 mm spot; 1-3 passes7,9; 34 J/cm2, 30 msec, 15 mm spot;10 25 J/cm2, 1.6 msec, 6 mm spot11 ||Stinging, hyperpigmentation ||None ||IB7,9-11 |
|Pulsed dye laser (585, 595 nm) ||Erythema (KP rubra) ||Ablation of superficial vessels ||4.5-11 J/cm2; 0.5-10 msec; 7-10 mm spot with goal of mild purpura ||Purpura, dyspigmentation ||None ||III12,13 |
Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized ...