The Effectiveness of Topical Keratolytics (Alpha Hydroxy Acids/Beta Hydroxy Acids/Urea) in Treating Keratosis Pilaris: A Review of the Literature

Keratosis pilaris (KP) is a highly prevalent, benign disorder of follicular keratinization characterized by rough keratotic papules and variable perifollicular erythema, most commonly affecting the extensor upper arms, thighs, and buttocks. Although medically harmless, KP is frequently associated with cosmetic distress, reduced self-confidence, and persistent dissatisfaction with skin texture and appearance. The fundamental pathological process involves follicular hyperkeratosis with retention keratosis and abnormal desquamation, often occurring in the context of xerosis and epidermal barrier dysfunction, including associations with atopic dermatitis, ichthyosis vulgaris, and filaggrin-related barrier impairment. These mechanisms provide a strong rationale for topical keratolytic therapy, which aims to reduce corneocyte cohesion, facilitate desquamation, soften keratin plugs, and improve hydration of the stratum corneum. Topical keratolytics remain reasonable first-line, symptom-directed options for KP, with AHAs, BHAs, and urea all demonstrating potential benefit. However, the overall evidence base is constrained by small sample sizes, heterogeneous outcome measures, limited blinding, and short follow-up, with sparse long-term maintenance data and limited differentiation between texture-dominant and erythematous KP phenotypes.