Keratosis Pilaris/Lichen Spinulosus
Saturday, January 01, 2011
Keratosis pilaris (KP) is an extremely common, often familial
disorder that usually does not require treatment. Involvement of
the face and upper arms, however, may cause a significant cosmetic
problem, and frictional folliculitis not infrequently complicates
KP on the buttocks and thighs. Keratosis pilaris is most frequently
seen in association with atopic dermatitis.
- Be sure that the patient understands that KP is not curable and
that any therapeutic option only minimizes but does not erase the
- A mild soap or a soapless cleanser should be used with a mild
abrasive scrub pad. This treatment may gradually remove follicular
plugs (over several weeks) and prevent new ones from emerging.
- Urea creams or lotions in concentrations of 10 to 20% may be
effective, and can be tolerated by many patients with atopic
- Ammonium lactate 12% lotion applied once daily after bathing is
also effective for KP. It may be combined with urea. Individuals
with atopic disease tend to tolerate high concentrations of lactic
acid (>5%) without some adjunctive therapy to control their
atopic condition. Alternatively, lower concentrations of lactic
acid or combinations of lactic acid and urea may be
- Topical medium strength steroid ointments may be effective in
KP associated with atopic dermatitis.
- A combination of salicylic acid 6% in propylene glycol 40%
applied before bed or after bathing. This therapy is particularly
effective when used in conjunction with a mild abrasive scrub pad
- Tazarotene 0.01% applied up to once daily can be effective in
KP. It may trigger atopic dermatitis.
- Retinoic acid 0.025% cream applied nightly, increasing to 0.05%
and 0.1%, as tolerated, may be used alternatively.
- After the keratinous plugs have been removed, an emollient
cream containing 20% urea may prevent reappearance of lesions.
- Use of the abrasive scrub pad should be resumed at the first
sign of reappearance of crops of new lesions.
- A "dry skin program" of bathing, mild soaps, and lubrication
also should be employed, as KP is almost invariably associated with
xerosis, and xerosis may, in fact, predispose to exacerbations of
- Both salicylic and lactic acids may be irritating, especially
when applied to inflamed skin. A medium-potency, topical
corticosteroid cream can be applied with these agents to reduce
- The side effects of topical retinoids are described in the
chapter on acne vulgaris.