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Keratosis pilaris is a 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 options 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 ineffective against inflammation. Prescription topical solutions should be applied two to four times a day as a thin layer that is spread onto the affected area. Like milder 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 over 30% can be used to alleviate rough portions of the dermis. However, the urea concentration contained in the legend solutions is commonly sensitizing and not a popular alternative.

Topical retinoids applied in the treatment of keratosis pilaris include adapalene, tazarotene, and tretinoin. Their mechanism of action can be to increase turnover of follicular epithelial cells. These agents must be applied as a thin layer to dry skin, at bedtime, to no more than 20% of the skin's surface. The negative effects of redness, strong dryness, and peeling are in some cases rate-limiting effects for most patients. However, some topical retinoids are available in minimal concentrations or in an emollient cream base when compared to the original solutions.

Contact of the retinoid with the eyes and mouth must be eluded. Also avoid exposure to ultraviolet light. Just like the AHAs, topical retinoids should be initially applied every other day with a low-concentration solution and increased to higher concentrations as tolerated. Burning and pruritus are commonly seen in the first four weeks and commonly lessen with time. Topical retinoids are teratogenic and must not be employed by women of childbearing age. One solution'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 must not use topical retinoids.

Topical immunomodulators, pimecrolimus, and tacrolimus can also be of benefit if other treatments have been ineffective. However, a public health warning has been issued by the FDA about a potential risk of skin cancer with the application of topical immunomodulators for the therapy of eczema.

These solutions must be applied twice daily to the affected areas. If a moisturizer is also being applied, the patient must be instructed to use the moisturizer after pimecrolimus. Patients must 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 week of use. Most of these reactions will commonly subside five to seven days after therapy. An advantage of the topical immunomodulators is that their use is indicated for children 2 years of age and older.

Another advantage is that these elements do not inhibit collagen synthesis and will not cause skin thinning. Occlusive dressings must be avoided with these agents. These agents must not be used in people with a compromised defensive system or during pregnancy since there are no complete and well-controlled researches of topically applied agents in pregnancy.