Keratosis pilaris is a 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 options to alleviate keratosis pilaris are topical corticosteroids, urea, retinoids, and topical immunomodulators. Topical use corticosteroids, e.g., triamcinolone 1% or desonide 0.05%, can be useful if over-the-counter products are found to be useless against inflammation. Prescription topical solutions should be used two to four times a day as a thin layer that is spread onto the afflicted area. Like milder concentrations of hydrocortisone, caution should be used with the prescription medicines. Additionally, prescription-strength hydrocortisone can inhibit collagen formation and thereby lead to skin striate.

Concentrations of urea greater than 30% can be used to alleviate rough portions of the dermis. However, the urea proportion contained in the legend products is usually sensitizing and not a popular choice.

Topical retinoids applied in the treatment of keratosis pilaris involve adapalene, tazarotene, and tretinoin. Their mechanism of action can be to elevate turnover of follicular epithelial cells. These agents must be used as a thin layer to dry skin, at bedtime, to no more than 20% of the skin's surface. The negative effects of redness, extreme 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 product base when compared to the original products.

Contact of the retinoid with the eyes and mouth must be eluded. Also avoid exposure to UV light. Just like the AHAs, topical retinoids should be initially applied every other day with a small-concentration solution and elevated to higher concentrations as tolerated. Burning and pruritus are usually seen in the first four weeks and usually lessen with time. Topical retinoids are teratogenic and must not be used by women of childbearing age. One solution's package insert recommends female patients should start therapy during a normal menstrual period. Prescribing data 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 therapies have been ineffective. However, a public health advisory 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 products must be applied twice daily to the afflicted areas. If a moisturizer is also being applied, the patient must be instructed to apply the moisturizer after pimecrolimus. Patients must 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 topical immunomodulators is that their use is approved for children 2 years of age and older.

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