Salicylic Acid and Acne: The Pro’s and Con’s
Salicylic acid is one of the most important treatments for acne on oily skin. The problems with most acne products that list salicylic acid as an ingredient are that they do not contain the right concentration of salicylic acid at the right pH.
- Salicylic acid is an exfoliant ingredient that is chemically similar to aspirin. Like aspirin, salicylic acid can remove redness and inflammation1 as it opens pores.
- Whether salicylic acid successfully exfoliates the skin depends on concentration and pH of the product. Exfoliant products that are too alkaline will not work.
- Anyone who uses salicylic acid must be sure to rinse it off according to product instructions. Some people should not use salicylic acid at all.
What Is Salicylic Acid?
If you have heard of salicylic acid, chances are that you know it as the primary ingredient in aspirin. The chemical gets its name from the Latin term for willow trees, salix, because it was first made from a complex carbohydrate found in willow bark2 . There are some companies that make acne care products claiming that they contain salicylic acid from willow bark, but the compound does not occur in the bark of the tree. The powdered bark has to be treated with oxidants and filtered to make the acid.
Salicylic acid is a very useful pain reliever. For a time, researchers even supposed it might be a vitamin, which they called “vitamin S.” Taken inside the body, salicylic acid relieves pain and improves circulation. Applied to the skin, it breaks down fatty compounds such as the oily sebum that can clog pores. In fact, it breaks down the fats and fat-like compounds in the skin so well that it is generally considered to treat facial skin3 with more than 2% salicylic acid with 98% of the lotion a neutral carrier agent. Up to 3% salicylic acid may be used on other parts of the body, and 10% to 30% will dissolve warts.
How Is Salicylic Acid Used to Treat Acne?
Applying a mild solution of salicylic acid directly to the skin yields many of the benefits of scrubbing, without the risk of rupturing pores or breaking tiny blood vessels. Salicylic acid treatment, however, has many benefits that simple scrubbing does not.
Gently removing dead skin does more than just open pores. Salicylic acid increases cell turnover4. This makes the skin grow faster, opening up pores. It increases collagen production, filling in indentations in the skin and making it less “floppy.” It removes discoloration from the skin, although it is often too strong for use on dark skin.
Salicylic acid is the only beta-hydroxy acid used in skin care. It accomplishes the same goals in skin care as alpha-hydroxy acids such as lactic acid and glycolic acid, but it is used in a much weaker concentration. Acne care products may contain as much as 30% alpha-hydroxy acids, but the same action is achieved by 0.5% to 2% salicylic acid5.
Similar to benzoyl peroxide, salicylic acid is most effective only if applied continually even after the acne has cleared. In the absence of the exfoliating and cleansing effects of salicylic acid, the pores can clog again resulting in the return of acne.
Salicylic acid is also used in many acne treatments as a combination therapy at low concentrations. The exfoliating effect of the acid help to enhance the efficacy of other active ingredients. As salicylic acid is effective at low concentrations, it is significantly less irritating than other products.
Who Benefits Most from Salicylic Acid in Acne Treatment?
There is an advantage of salicylic acid over other products to open pores that is due to its close relationship to aspirin. Like its chemical cousin aspirin (acetylsalicylic acid), salicylic acid can stimulate circulation, in this case, it can stimulate circulation of oil out of pores. Also like aspirin, it can relieve inflammation6 and redness. As long as salicylic acid is used at the right concentration, it can produce better skin color than alpha-hydroxy acids. Salicylic acid is especially useful on oily skin.
Not everyone, however, benefits from skin treatment with salicylic acid. Dermatologists advise caution in the use of salicylic acid on three skin types on the Fitzpatrick scale7:
- Fitzpatrick Scale Skin Type IV. This is beige to brown skin, a Mediterranean or Hispanic skin type. This skin type only gets mild sunburn and tans gradually.
- Fitzpatrick Scale Skin Type V. This is dark brown skin that almost never gets sunburn and that tans easily.
- Fitzpatrick Scale Skin Type VI. This is black skin that never burns and that tans very easily.
These skin types contain many cells that produce the pigment melanin. The skin uses this antioxidant pigment to limit inflammation. Since salicylic acid inflames the skin, albeit in a good way, and these skin types can make large amounts of melanin, the risk is that acne can (and often is) replaced by brown or black skin spots. Anything else that inflames the skin, whether intentional (for example, a lightening agent) or unintentional (for instance, an infection or acne itself), can also leave permanent darkening on the skin. If you have beige to black skin, you should only use salicylic acid under professional supervision.
Salicylic acid based treatments generally do a good job of getting rid of blackheads and large pimples. If you have large, red, oily zits, salicylic acid may help you to reduce them. It is also a good choice for dealing with scarring and hyperpigmentation once the pimple is gone.
How to Use Salicylic Acid to Open Pores
If you have fair skin, especially if you have oily skin, then you may benefit a great deal from using salicylic acid to open pores. The first thing to know about choosing a salicylic acid product to treat your skin is that it has to be sufficiently acidic to break down fats and open pores. This means that the product has to have a pH of about 4 or lower (more about the importance of pH levels here). It has to be acidic enough that it is likely to sting. And while Salicylic acid does not kill acne causing bacteria, it helps to unclog the pores that harbor these bacteria.
Higher pH products won’t sting, but they won’t open pores, either.
The next thing to look for in a salicylic acid product is the right concentration. Too much salicylic acid can burn the skin. Too little salicylic acid won’t open pores. Most products that work provide 1% to 3% of this ingredient, possibly as little as 0.5%8, but never more than 3% (unless treating warts).
Salicylic acid in a face wash won’t help your skin, because you rinse it off almost as soon as you put it on. Salicylic acid in a powder is not at the right pH to have any effect on skin. Only salicylic acid in the form of a gel that stays on the skin will do any good, but it is essential not to leave the product on the skin any longer than directed, to remove it as directed, and not to use the product around the eyes.
Notes and Precautions Before Using Salicylic Acid Based Acne Treatments
Salicylic acid is generally a safe compound when applied at proper concentrations for the treatment of acne. However, one thing that you might notice with salicylic acid based acne products is the fact that sometimes, they may leave your skin a bit dry. So it should go without saying that you should avoid any harsh cleansers and astringents while using salicylic acid based products.
It is very important to make sure that you have a balanced acne regimen, especially if you are using salicylic acid based products. Make sure that you are regularly moisturizing your skin and using soothing products while using a salicylic acid based treatment. Also, make sure that you are not applying salicylic acid to extensive areas of your skin, stick to the areas that have pimples on them. If your skin is broken, swollen, red or infected, avoid using salicylic acid based products.
What Are Some Salicylic Acid Products That Work?
Ineffective salicylic acid products are easy to find, but it takes some effort to find products that work. Some good beta-hydroxy acid exfoliants9 are:
- Neutrogena Oil-Free Acne Stress Control 3-in-1 Hydrating Acne Treatment (best for oily or “combination” skin)
- Exposed Skin Care complete acne kit (for all skin types)
- Paula’s Choice 1% Beta-Hydroxy Acid Gel (for all skin types)
- Jan Marini Factor-A Plus Mask (for normal to dry skin)
- Clinique Skin Conditioning Treatment (for normal to dry skin)
- And many other choices in the US $75 to $300 range.
If you are on a budget, at US $8 Neutrogena is your best choice among the drugstore brands, and at US $20 Paula’s Choice is your best choice among the cosmetic counter brands.
- Arif T. Salicylic acid as a peeling agent: a comprehensive review. Clinical, Cosmetic, and Investigational Dermatology. 2015; 8: 455–461.
- Norn S., Permin H., Kruse P.R., Kruse E. From willow bark to acetylsalicylic acid. Dan Medicinhist Arbog. 2009;37:79-98.
- Sacchidanand S.A., Lahiri K., Godse K., Patwardhan N.G., Ganjoo A., Kharkar R., Narayanan V., Borade D., D’Souza L. Synchronizing Pharmacotherapy in Acne with Review of Clinical Care. Indian Journal of Dermatology. 2017;62(4):341–357.
- Zeichner J.A. The Use of Lipohydroxy Acid in Skin Care and Acne Treatment. The Journal of Clinical and Aesthetic Dermatology. 2016;9(11):40–43.
- Zander E., Weisman S. Treatment of acne vulgaris with salicylic acid pads. Clinical Therapeutics (Journal). 1992;14(2):247-53.
- Lekakh O., Mahoney A.M., Novice K., Kamalpour J., Sadeghian A., Mondo D., Kalnicky C., Guo R., Peterson A., Tung R. Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial. Journal of Lasers in Medical Sciences. 2015;6(4):167–170.
- “Table 3: Fitzpatrick Skin Type,” The Surgeon General’s Call to Action to Prevent Skin Cancer. US Department of Health and Human Services: Office of the Surgeon General (US). 2014.
- Decker A., Graber E.M. Over-the-counter Acne Treatments: A Review. The Journal of Clinical and Aesthetic Dermatology. 2012;5(5):32–40.
- Kornhauser A., Coelho S.G., Hearing V.J. Applications of hydroxy acids: classification, mechanisms, and photoactivity. Clinical, Cosmetic, and Investigational Dermatology. 2010;3:135–142.
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