Urea Cream: Why Are There Different Over-the-Counter Strengths?

If you have dry, rough, or thick skin, chances are you've heard of the line of products commonly called urea cream. At first glance, urea products seem almost the same. They have similar ingredients, and most of them are labeled to help relieve dry, itchy, or flaky skin. 

However, like with most things, it’s not that simple. Urea products come in many different strengths, and they’re also found as stand-alone (urea-only) and combination products. Reviewing the differences between urea cream products will help you choose the right one for you.

What is urea cream?

Urea is a keratolytic (tissue or skin softening) medication that's applied to the skin or nails. While urea is found in many over-the-counter (OTC) skincare products, a prescription may be needed depending on the formulation. It’s commonly found as a cream, but it’s also available as gel, lotion, and foam. 

The main ingredient in urea cream is, surprise, urea. Urea creams also contain various inactive ingredients depending on which urea product you're using. These inactive ingredients may include substances like mineral oil, purified water, or propylene glycol. 

Urea can also help other medications penetrate and absorb into the skin better. In prescription medications, urea can be combined with anti-inflammatory topical steroid creams, such as hydrocortisone. It can also be combined with topical antifungal medications like ciclopirox. 

But what is urea? It’s a natural molecule in your body. It's found in the outermost layer of your skin. Urea naturally hydrates and softens skin, so urea cream is used to do the same. 

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What does urea cream treat?

Urea cream can be used to help relieve dry, flaky, or itchy skin in many situations. And in some health conditions that cause your skin to be too rough or thick, urea cream can help soften and break it down. 

Urea cream also has many specific uses. For instance, treating:

• Dry skin 

• Eczema

• Psoriasis

• Ichthyosis (itchy, dry, scaly skin)

• Corns and calluses

• Keratosis pilaris (rough, tiny bumps)

• Athlete’s foot 

• Damaged and ingrown nails

How do you use urea cream?

Urea cream is generally applied directly to the affected area twice daily. But how often you apply urea will depend on the product and your skin condition. Different urea products have unique instructions on how to use them, so make sure to follow the instructions on your specific urea product. 

In general, you'll want to avoid applying urea on or near your eyes, lips, or groin area. You'll also want to allow the cream to dry on your skin or nails completely. 

You can apply the cream with your hands. But make sure to avoid touching your eyes until you have washed your hands with soap and water after applying urea cream.

If your condition doesn’t improve after 2 weeks, or gets worse at any point, contact your healthcare provider for guidance.

What strengths does urea cream come in?

Urea cream is available in many potencies. The potency, or strength, of urea cream is the amount of medication needed to produce an intended health effect. Different strengths exist because some preparations may be more useful in certain situations than others. 

Urea cream comes in several strengths, ranging from 2% to 50%. Common strengths include:

• 2%

• 5%

• 10%

• 20%

• 37.5%

• 39%

• 40%

• 41%

• 42%

• 45%

• 47%

• 50%

With urea cream, there actually isn’t a clear line between what strengths are available OTC and which are available with a prescription. In general, combination products tend to require a prescription, but urea-only products are available OTC or with a prescription. 

Based on your situation, your pharmacist or healthcare provider can tell you which strength of urea cream is ideal for your situation and how to access it. 

When would low-dose urea be useful?

Low-dose urea — between 2% and 10% — acts as a skin moisturizer. It’s an option to consider when treating dry skin.

Low-dose urea creams can be found in stand-alone products or mixed with other ingredients. One example of a combination product is U-Cort, a medication that combines hydrocortisone and low-dose urea. Keep in mind that creams with hydrocortisone shouldn’t be used for a long time — usually no more than 2 weeks at a time.

When would medium-dose urea be useful?

Medium-dose urea — between 10% and 30% — acts as a skin moisturizer and tissue softener. 

Medium-dose urea can also treat dry skin, but it may be more useful than low-dose urea for treating conditions that cause rough skin patches, such as eczema or psoriasis. 

When would high-dose urea be useful?

High-dose urea — between 30% and 50% — acts as a tissue softener. It can help remove or exfoliate damaged skin.

High-dose urea is ideal for treating thick, dry, or scaly skin, corns and calluses, or heel cracks. It may also be recommended over medium-dose urea for more serious cases of conditions like eczema or psoriasis. High dose-urea is also often used for nail problems. 

Does urea cream have any side effects or risks?

Urea cream is generally well-tolerated when used as directed. But there are still a few side effects to keep in mind. 

You may experience redness, stinging, or burning in the area of skin where you apply urea cream. But side effects are usually temporary, and they’re more likely to happen with higher strengths. If any side effects become worrisome or don’t go away, talk to your pharmacist or healthcare provider for guidance right away. 

Urea cream is only meant to be used externally. It's important to avoid swallowing it. If you have urea cream in your house, keep the bottle or tube in a place your children can't reach. If your child accidentally swallows urea cream, you should call Poison Control at 1-800-222-1222. They can let you know if they need any emergency treatment. 

Who shouldn’t use urea cream?

Most people can use urea cream without experiencing any serious problems. But if you're pregnant or trying to become pregnant, make sure to talk to your OB/GYN before using products that contain urea. While we still don't know if they can cause birth defects, some healthcare providers feel it's better to be safe and not use urea while you're pregnant. This is because we don’t have much human data on urea cream’s safety in pregnancy.

This is also true for breastfeeding. If you're nursing and are interested in using urea cream, talk to your healthcare provider to see if it’s safe for you to use.

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Written by:

Nikki Javit, PharmD

Nikki Javit, PharmD, is a clinical pharmacist with certifications in international travel medicine, immunization delivery, and pharmacogenomics. She received her bachelor’s of science in biology from Indiana University Bloomington and her doctor of pharmacy degree from Butler University.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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