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 urea, corticosteroids, retinoids, 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 agents should be applied two to four times a day as a thin layer that is spread onto the affected area. Just as with softer concentrations of hydrocortisone, caution should be observed with the prescription medicines. Additionally, prescription-strength hydrocortisone may inhibit collagen formation 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 usually sensitizing and not a popular choice.

Topical retinoids applied in the therapy 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 body's surface. The negative effects of redness, strong dryness, and peeling are in some cases rate-limiting issues for most patients. However, some topical retinoids are available in reduced 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 UV light. Just like the AHAs, topical retinoids should be initially applied every other day with a low-concentration solution 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 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 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 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 week of use. Most of these reactions will usually 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 agents do not inhibit collagen production and won't cause skin thinning. Occlusive dressings must be avoided with these agents. These agents must not be used in people with a compromised immune system or during pregnancy since there are no complete and well-controlled researches of topically applied agents in pregnancy.