Keratosis pilaris is a very common genetic follicular disorder manifested by the presence of coarse bumps on the skin and hence colloquially referred to as "chicken skin" or "goose bumps".

Prescription treatment alternatives to treat keratosis pilaris are topical urea, retinoids, corticosteroids, and topical immunomodulators. Topical prescription corticosteroids, like triamcinolone 1% or desonide 0.05%, can be useful if over-the-counter products are found to be ineffective against inflammation. Prescription topical agents should be used two to four 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 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 surfaces of the dermis. However, the urea proportion contained in the legend products is usually 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 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, extreme dryness, and peeling are in some cases rate-limiting effects for most people. However, some topical retinoids are available in reduced concentrations or in an emollient cream base when compared to the original products.

Contact of the retinoid with the eyes and mouth should be avoided. Also avoid exposure to UV light. Just like the AHAs, topical retinoids should be initially applied every other day with a small-concentration product and elevated to higher concentrations as tolerated. Burning and pruritus are usually observed 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 suggests female patients should start 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 can also be of benefit if other treatments have been ineffective. However, a public health advisory has been issued by the FDA about a potential danger of skin cancer with the application of topical immunomodulators for the treatment of eczema.

These products should be applied twice daily to the afflicted areas. If a moisturizer is also being applied, the patient should be instructed to use the moisturizer after pimecrolimus. Patients should be cautioned to avoid exaggerated 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 agents do not inhibit collagen synthesis 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 studies of topically used agents during pregnancy.