Patients with keratosis pilaris should be treated in the primary care service, with a few exceptions. Many patients will be satisfied to learn that the condition is common and does not need to be treated. Patients who find it troublesome will benefit from the application of moisturising creams, keratolytic agents and prescription-only creams.
Moisturising creams strengthen the skin barrier and add moisture to the skin. Unscented creams should be chosen to avoid the development of contact allergy to fragrances. Creams containing lactic acid, propylene glycol, salicylic acid and urea are particularly effective because they also have a keratolytic action (1, 11).
Camouflage creams containing green pigment may be effective for camouflaging the erythema in keratosis pilaris rubra. Dry brushing, exfoliating gloves or pumice can be used to remove bumps and hard skin. Climatotherapy, with exposure to sunlight and saltwater, has been shown to help. Therefore, the condition is often found to improve in summer and worsen in winter (1). Treatment with shortwave ultraviolet light (UVB) can be effective.
In severe cases, prescription-only drugs such as topical retinoids and calcineurin inhibitors can be tried. Retinoids have a comedolytic and anti-inflammatory effect, but can cause erythema and skin irritation. Calcineurin inhibitors, in the form of pimecrolimus or tacrolimus, work by reducing the amount of pro-inflammatory cytokines in the skin, but can cause a transient burning sensation at the application site. The products are registered for the indication of atopic eczema. Local corticosteroids are not indicated, apart from for eczematous skin resulting from scratching (1, 11). Topical vitamin D derivatives have no effect (1).
The patient should be referred to the specialist health service if the diagnosis is uncertain, symptoms are severe or it is suspected that keratosis pilaris is part of a syndrome. It has recently been reported that local treatment with sirolimus, an mTOR inhibitor, is effective in keratosis pilaris rubra (12). Sirolimus inhibits T-lymphocyte-mediated immune reactions and also has an antiproliferative effect on blood vessels. It is not available as a topical drug, but has been compounded and used successfully off-label for angiofibroma associated with tuberous sclerosis (13, 14).
Laser treatment, primarily Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser or pulsed dye laser, can also be effective in keratosis pilaris that is resistant to other treatment, particularly keratosis pilaris rubra and keratosis pilaris atrophicans (2, 15). These types of laser are effective in treating erythema, while fractional CO2 laser will work better for atrophy and scarring (15). Adverse reactions are transient erythema and oedema following treatment, as well as the risk of post-inflammatory pigment changes (2). Public funding for this type of laser treatment is not available for this indication in Norway.