Acne is a common skin disorder affecting around 45 million Americans. Between 81% and 95% of adolescent boys and 79%–82% of girls are likely to struggle with the condition. Acne is not confined to adolescents; approximately 3% of men and 12% of women suffer from adult acne.¹
Many people try over-the-counter treatment for their acne before seeing a doctor or dermatologist. This is especially helpful if access to a medical professional is limited by cost or geographical location.
Salicylic acid is one of the most common over-the-counter acne treatments. Read on to find out how to use salicylic acid to clear up your acne.
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Salicylic acid (SA) was originally derived from the bark of the willow tree, although now the compound is manufactured artificially.² It is related to acetylsalicylic acid, the active ingredient in aspirin. SA belongs to the class of chemicals known as β-hydroxy acids (BHA) – organic compounds that contain carboxylic and hydroxy functional groups.³
To understand how SA helps get rid of acne, it’s important to know a bit about the basic pathology of the condition.⁴
Acne occurs when hair follicles, or pores, become blocked with dead skin cells and sebum (the oil naturally produced by your body to lubricate your skin and hair). Blocked pores can then become infected with bacteria (typically Cutibacterium acnes).
There are different types of acne bumps, depending on whether the blocked pores have become inflamed and how deep or superficial the lesions are.⁴
Salicylic acid treats acne in three different ways:¹
SA breaks the bonds between skin cells (it has desmolytic properties), making it an exfoliant. This is why higher concentrations of SA can cause mild peeling of your skin. By breaking down the bonds between your skin cells, SA decreases the number of dead ones clogging up your pores. This physiological exfoliation gives a smoother texture and appearance to your skin and can create the illusion of decreased pore size.
It has comedolytic properties.¹ It is able to penetrate the blocked hair follicle and break down the sebum clogging the pore.²
It has mild anti-inflammatory properties so it reduces some of the inflammation, redness, and discomfort caused by acne.²
SA is mainly used in the treatment of mild acne. Combined with other agents, it may have a place in the management of moderate acne.⁵ SA is not an effective treatment for severe acne, where there are deep nodules, cysts, and sinuses.
A 12-week study compared the use of 0.5% salicylic acid twice daily with the use of a placebo in people with mild to moderate acne. By the end of the study period, the people using SA had reduced numbers of open comedones and inflammation compared with the group using the placebo treatment.¹
Stronger concentrations of SA (30% salicylic acid) have been shown to be comparable to glycolic acid (30%) when used topically as a peel in mild to moderate facial acne, with fewer initial side effects.¹ The effects of the SA lasted two months after completion of treatment.
Before starting a course of SA for your acne, check that you aren’t allergic to it and that it doesn’t cause significant irritation to your skin. To do this, apply the SA treatment to a small area of affected skin daily for three days. If no reaction or discomfort occurs, you can go ahead with the treatment according to the instructions on the product.
Salicylic acid comes in a variety of strengths and formulations.⁶ Some of those most commonly used for acne are:
Gel is usually available in strengths of 0.5% to 5%. Apply the gel once a day to the affected area and rub it gently into the skin, then leave it on. The gel is safe for adults and children over two years of age.
The lotion is available in strengths of 1% to 2%. It should be gently rubbed onto the affected area one to three times a day and left on. The lotion is safe for adults and children over two.
Salicylic acid ointment comes in different strengths from 3% to 6%. The ointment should be used daily (rubbed gently onto the affected area and left on the skin) and is safe for adults and children over two.
Ready-for-use pads infused with SA can be wiped over the affected area one to three times daily. The skin should not be rinsed after use. Pads are safe for adults and children over two.
5. Topical solution
SA topical solution comes in strengths of 0.5% to 2%. The solution should be applied to a cotton ball or pad and wiped on the affected area. Do not rinse your skin afterward, and discard the pad after use. A topical solution can be used one to three times daily and is safe for adults and children over two.
Salicylic acid in any form should be used externally only. Avoid any contact with your eyes, mouth, and inside of your nose.
SA is generally considered safe to use.² At concentrations of less than 2%, it can cause mild dryness, itching, redness, or peeling of the skin. These side effects are usually temporary and are likely to subside after a few weeks of treatment.
At higher concentrations, SA can cause more substantial skin peeling and stinging on application.
SA is absorbed more readily by the skin of infants, so should not be used on children younger than two years.
Salicylic acid is safe to use topically at the recommended doses while pregnant.⁷ It does not appear to be excreted in breastmilk if used as recommended and is safe to use for your acne while you are breastfeeding. Avoid applying it to areas that may come in contact with your baby’s mouth.⁸
If you use SA for a prolonged time over a large area of skin, it may be absorbed by your body and cause systemic side effects.² Using SA under airtight wraps or occlusive dressings can also increase absorption, potentially leading to salicylic acid toxicity.
Stop using SA and contact your doctor immediately if you experience any of the following:
Elevated breathing rate
Ringing in the ears or hearing loss
Nausea, vomiting, or diarrhea
Metabolic abnormalities such as elevated liver function tests
Salicylic acid is a commonly used over-the-counter treatment for acne. It works by physiologically exfoliating the skin, breaking down blockages in pores, and decreasing inflammation.
Studies have shown salicylic acid to be effective for mild to moderate acne. It comes in various strengths and formulations. Popular formulations are gel, lotion, topical solution, and pads. Choose the one that works best for you. Depending on the strength, you could apply salicylic acid one to three times daily.
Salicylic acid is generally safe to use over the age of two years and has minimal side effects.
Salicylic acid | acne.org
Acne (acne vulgaris) | MSD Manual Consumer Version
Salicylic acid (topical route) | Mayo Clinic
Skin conditions during pregnancy | The American College of Obstetricians and Gynecologists (ACOG)
Salicylic acid | National Center for Biotechnology Information (NCBI)