Treatment |
Study |
Study design |
Subject age |
Subjects (N) |
Conclusions |
Topical and systemic therapies |
|
|
|
|
|
LA vs. SA |
Kootiratrakarn et al. [243] 2015 |
Prospective, randomized, clinical |
NR |
50 |
10% LA or 5% SA BID for 12 weeks: reduction of KP lesions in 66% of LA group and 52% of SA group (p<0.05 for each). Conductance improved with both, but no effect on transepidermal water loss. Adverse effects: mild local irritation |
LA, SA, tretinoin, topical corticosteroids, systemic antibiotics, and/or isotretinoin |
Baden and Byers [34] 1994 |
Prospective cohort |
12–48 years |
21 |
KPA: SA and LA smoothened skin without complete clearing. 14 used topical corticosteroids, with/without tretinoin: helped partially. Five used systemic antibiotics: minimal, transient improvement. Three received isotretinoin: minimal responses, one flared |
SA and urea |
Novick [244] 1984 |
Treatment recommendation |
NR |
30 |
Combined with short showers and topical corticosteroids for inflammation, SA and urea QD are effective for widespread, atypical KP. 75–100% clearance achieved in 2–3 weeks |
Aquaphor vs. tacrolimus |
Breithaupt et al. [248] 2011 |
Double-blind, bilateral paired comparison |
2–16 years |
30 |
27 pts completed study, Aquaphor to one limb and tacrolimus to the other BID for 4 weeks: improved investigator's global assessment score was 81% for tacrolimus and 78% for Aquaphor, both improved vs. baseline (tacrolimus: p<0.001, Aquaphor: p<0.005). Tacrolimus more likely to have marked effect. Adverse events: mild and transient |
Tazarotene |
Gerbig [247] 2002 |
Open with consecutive recruitment |
NR |
20 |
KP improved with QD application as early as 2 weeks, gradually fading from 4–8 weeks |
Tretinoin |
Patel et al. [238] 2016 |
Case series |
55–56 years |
3 |
Three cases of KP induced by nilotinib, dasatinib, or ponatinib: slight improvement |
LA, urea, propylene glycol, emollients, surgras soap, topical corticosteroids, oral corticosteroids, and antihistamines |
Castela et al. [21] 2012 |
Prospective cohort |
10 months–3 years |
11 |
Not effective: emollients, topical corticosteroids, oral corticosteroids, antihistamines, surgras soap. Partially effective: propylene glycol, LA, urea |
Calcipotriol |
Kragballe et al. [252] 1995 |
Randomized, double-blind, vehicle-controlled, right/left comparative |
16–45 years |
9 |
KP appears unresponsive to calcipotriol |
Combination peel with incorporated fractional prickle coral calcium |
Park et al. [249] 2014 |
Pilot |
12–41 years |
16 |
Five treatments of KP on upper arms at 2-week intervals: improvement in erythema (p=0.011) and melanin (p=0.006) index of mexameter relative to baseline, maintained at 2-month follow-up. Adverse events: mild and transient, including erythema, pruritus, stinging |
Ammonia-oxidizing bacteria (Nitrosomonas eutropha) spray-on mist |
Lee et al. [250] 2018 |
Double-blinded, placebo-controlled, split-arm |
18–65 years |
24 |
4 weeks of BID treatment for KP: larger % reduction in height of follicular papules by quantitative digital topographic analysis in the treatment group (18% vs. 15.2%;p=0.007) |
Chlorine dioxide complex cleanser |
Zirwas and Fichtel [251] 2018 |
Case series |
11–28 years |
5 |
90–100% of KP papules resolved from 2 days to 1 month with QD treatment |
Energy-based therapies |
|
|
|
|
|
Photopneumatic therapy |
Ciliberto et al. [254] 2013 |
Pilot |
13–45 years |
10 |
One treatment: erythema and skin texture of KP improved for at least 1 month (skin types I–III). Adverse events: transient hypopigmentation, purpura |
Intense pulsed light |
Rodríguez-Lojo et al. [255] 2010 |
Case series |
14–20 years |
4 |
5–9 sessions for KPA: reduced erythema 75–100%, reduced skin roughness with no adverse effects, no recurrence after 10 months |
<600 nm: KTPL and PDL |
Schoch et al. [256] 2016 |
Case series |
14–16 years |
8 |
1–4 treatments with PDL: all pts reported improved erythema in KPR. Six pts sustained results up to 19 months |
|
Alcántara González et al. [257] 2010 |
Case series |
8–35 years |
10 |
2–7 sessions of PDL: all pts with KPR (8/10) or KPAF (2/10) had marked reduction in erythema, low incidence of adverse events |
|
Clark et al. [258] 2000 |
Prospective cohort |
5–23 years |
12 |
2–8 treatments: PDL reduced KPA-associated erythema (p<0.05) and may improve skin roughness, minimal adverse events |
|
Kaune et al. [259] 2009 |
Case report |
17 years |
1 |
Erythema and follicular hyperkeratosis of severe KPR and KPAF: marked improvement with PDL every 6 weeks, remained stable for 9 months |
|
Dawn et al. [59] 2002 |
Case report |
15 years |
1 |
Topical clobetasone butyrate: minimal effect, but seven treatments of KTPL at 6-to 8-week intervals reduced erythema, cleared keratotic papules of KPR |
Combination of 595-nm PDL, long-pulsed 755-nm alexandrite laser, and microdermabrasion |
Lee et al. [261] 2013 |
Retrospective |
19–45 years |
26 |
51.7% of KP pts, all type IV skin: marked improvement or total clearance in erythema, skin texture, brownish dyschromias without significant side effects, except scaling with microdermabrasion |
|
Lee et al. [260] 2012 |
Case series |
23 and 28 years |
2 |
4 months after final treatment: marked improvement in KP, satisfied with results |
810 nm: long-pulsed diode laser |
Ibrahim et al. [262] 2015 |
Split-body, rater-blinded, parallel-group, balanced (1:1), placebo-controlled RCT |
18–65 years |
23 |
18 KP pts with skin types I–III completed study: three treatments induced improvement in overall severity (p=0.005), skin texture (p=0.004), but erythema did not improve (p=0.11) |
1064 nm: Q-switched Nd:YAG laser |
Saelim et al. [263] 2013 |
Split-body RCT |
15–42 years |
18 |
Three treatments at 4-week intervals: 17 KP pts completed trial, improvement in erythema (p=0.009), global assessment (p=0.007), quantity of keratotic papules (p=0.009). All reported improvement, satisfaction |
|
Park et al. [264] 2011 |
Pilot |
18–35 years |
12 |
Ten treatments once every 2 weeks for KP: skin texture, dyspigmentation improved>25% in 11/12 pts, texture improved>50% in 6/12 pts, dyspigmentation improved>50% in 5/12 pts. 11/12 pts satisfied. No significant adverse events |
Combination of 1064 nm: Q-switched Nd:YAG laser and topical urea |
Kim [245] 2011 |
Pilot |
19–29 years |
10 |
Five weekly laser treatments, urea emollient application BID: all pts (skin types IV–V) improved in postinflammatory hyperpigmentation associated with KP (p<0.05). Minimal adverse events |
10,600 nm: fractional carbon dioxide laser |
Vachiramon et al. [265] 2016 |
Prospective, randomized, single-blinded, intraindividual comparative |
19–32 years |
24 |
All pts reported improvement in KP after one treatment. 30% of 20 pts completed study: moderate–good improvement by physician's assessment at 12 weeks. Hyperpigmentation, keratotic papules responded better than erythema. Darker skin types may develop transient pigment changes |