Nicole Hangsterfer, PA-C
Sep 24, 2020 · 8 min read
Welcome to Ask Curology, a column penned by one of our in-house medical providers in response to your questions about all things skincare. This week, we’re talking about everybody’s favorite beta hydroxy acid: salicylic acid. You might have heard this ingredient is tough on acne—but is it too tough? Below, one of our medical providers gives the scoop on salicylic acid safety.
When I was younger, I’d get the occasional pimple, but lately, I’ve been breaking out intensely all over my face, neck, and back. My mom told me salicylic acid is good for acne, so I looked for products with that ingredient. I’ve been using a face wash, body wash, and spot treatment with salicylic acid every day. At first, my skin started to clear up. But now, my face is as red as a tomato. It’s even getting dry and flaky in areas, and I definitely didn’t have that problem before. It’s like I took one step forward and two steps back. What should I do?
Signed, Sally Silly Acid
Your mom is right; salicylic acid can be great for acne. It’s a powerful ingredient that cleans deep down into pores to help treat breakouts.¹
That said? Not all salicylic acid products are created equally. Some products that contain salicylic acid can be too intense for everyday use. And when it comes to salicylic acid it is possible to have too much of a good thing. It sounds like the number of salicylic acid products you’re using daily is too much for your skin to handle.
Salicylic acid is an exfoliant. Dr. Whitney Tolpinrud, a board-certified dermatologist at Curology says, “Skin naturally produces oil, called sebum, in the sebaceous glands. An overproduction of sebum is one factor that can lead to clogged or blocked pores, which can lead to acne. Salicylic acid is oil-soluble, so it can penetrate through the sebum of a clogged pore to the lining of the pore. Salicylic acid can also buff away dead skin cells. In this way, salicylic acid helps to prevent and treat blocked pores.” This makes it a great option for saying goodbye to whiteheads and blackheads (and other types of acne).
People with all skin types can use products with salicylic acid, but we often recommend them for people with oily skin. No matter what your skin type, though, it’s important to go slowly when introducing a new product with salicylic acid. In general, we suggest starting 1–2 times per week, and increasing the frequency as tolerated.
You can use either a cleanser with salicylic acid or a different salicylic acid product, but we don't typically recommended using both. If you opt for a toner or wipe with salicylic acid, prep your skin by washing your face with a gentle, non-salicylic acid cleanser first. Remember to allow your skin to dry completely before applying any prescription acne medication (like your Curology medication).
Salicylic acid can be helpful, but exfoliation is easy to overdo! Redness, tightness, soreness, and sensitivity can occur with overuse.² If you experience any of these symptoms, your skin likely needs a break. Consider stopping any exfoliating products (including salicylic acid) until your skin returns to normal, and then slowly reintroduce the salicylic acid product. If you feel your reaction is more significant, please reach out to your Curology provider or an in-person medical provider to learn if there could be another issue at hand.
Do you have skin allergies or just sensitive skin? Click here to learn more.
At Curology, we’re all about helping you achieve the healthiest skin possible. When we recommend products, it's because they contain ingredients we think can lend a hand in getting you there. Here are some options you can try.
Dermalogica Clearing Skin Wash with 0.5% salicylic acid (this lower strength can be a good option for those with sensitive or dry skin)
Neutrogena Oil-Free Acne Wash with 2% salicylic acid
The Inkey List BHA Serum with 2% salicylic acid
If you’re wondering what percentage of salicylic acid is best for you, a dose of 2% salicylic acid is generally well-tolerated by most people. If you’re just starting out or have dry or sensitive skin, you might do better with a lower strength, like 0.5%. When in doubt, consult your medical provider if you have any questions or concerns.
The acne body wash by Curology with 2% salicylic acid
Neutrogena Body Clear Body Wash with 2% salicylic acid
Dermalogica Clearing Skin Wash with 0.5% salicylic acid
Stridex (red box) Wipes with 2% salicylic acid
Paula’s Choice 2% BHA Liquid with 2% salicylic acid
Paula’s Choice RESIST Advanced Pore Refining Treatment with 4% salicylic acid
The reasons why experts often recommend products that contain salicylic acid to treat blemishes are many. Here are the ingredient’s top benefits:
Exfoliates. Salicylic acid is a chemical exfoliator that helps to gently remove excess dead skin cells that may contribute to clogged pores.³
Fights comedones. Salicylic acid is particularly effective at treating comedones such as whiteheads and blackheads.
Reduces inflammation. Salicylic acid also has anti-inflammatory properties to help fight acne.⁴
Salicylic acid does have some potential side effects, including irritation and stinging.⁵ But as long as you’re not overdoing it, side effects shouldn’t be extreme. That said, it is possible to overdo it—so keep an eye out to see how your skin reacts as you use products with salicylic acid.
Salicylic acid is available in many over-the-counter products, making it one of the more accessible go-to ingredients for treating and helping to prevent breakouts. But before you start using salicylic acid, there are a few precautions to consider and factors that may increase risk. If you’re ever not sure if salicylic acid is right for you, you can always talk to an expert at Curology or your in-person dermatology provider. Out of caution, just be aware of the following:
Allergic reactions. Some medications, including salicylic acid, may cause allergic reactions. If you’re concerned that you may have an allergic reaction or are prone to reactions from topical medications, speak with your medical provider before beginning a salicylic acid treatment.
Irritation. Other topical treatments such as retinoids, those containing certain types of alcohol, or harsh skincare products may cause irritation when combined with salicylic acid.
Pregnancy. While some acne medications are not recommended during pregnancy, low salicylic acid is generally considered safe to use during pregnancy—in small amounts.⁶ Still, it’s recommended to get your medical provider’s approval to use salicylic acid while pregnant.
Other ingredients. Salicylic acid can be great for treating breakouts and helping to prevent future ones. Still, depending on the specific type of acne you’re experiencing, you may see more benefits by using another ingredient in place of salicylic acid.
Kidney disease or liver disease. In rare cases (like very rare!), a severe condition known as salicylate toxicity could occur (more often among people with kidney disease or liver disease).⁷
Tretinoin. Tretinoin is a prescription retinoid that has been shown to effectively treat acne and reduce the appearance of fine lines.⁸ But if combined with salicylic acid, it could lead to irritation. If you’re using tretinoin and want to try a salicylic acid product, start with a low strength and go slow!
Benzoyl peroxide. Benzoyl peroxide is another powerful acne-fighting ingredient that is particularly good for reducing inflammatory acne lesions,⁹ but if used along with salicylic acid, it may also cause irritation.
Sulfur. Sulfur is another topical ingredient that may be too much for the skin when combined with salicylic acid.
Hyaluronic acid. Hyaluronic acid is great for hydrating your skin.¹⁰ After using a product that contains a potentially drying ingredient like salicylic acid, a moisturizer with hyaluronic acid can help keep your skin extra happy.
Many different products contain salicylic acid, so deciding how to use this acne-fighting ingredient is up to you. The best way to use salicylic acid in your skincare routine will depend on what kind of product it’s found in. Since many face washes contain salicylic acid, you can use these cleansers as you normally would in the morning or evening. If you’re using salicylic acid as a toner or topical acne treatment, you can use it after washing your face. As with any skincare routine, remember to use face lotion to help keep dryness and potential irritation away.
As always, if you have any questions, feel free to reach out to your Curology provider. If you’re not yet a member, you can sign up for a free month of Curology*. Members get paired with an in-house licensed dermatology provider for a skincare consultation and customized formula for their skin’s needs.
Curology brings dermatologist-designed skincare right to your door. Personalized for you so you can be sure the ingredients are the best for your skin.
Salicylic acid is an exfoliant. Dr. Whitney Tolpinrud, a board-certified dermatologist at Curology says, “Salicylic acid is oil-soluble, so it can penetrate through the sebum of a clogged pore to the lining of the pore. Salicylic acid can also buff away dead skin cells. In this way, salicylic acid helps to prevent and treat blocked pores".
People with all skin types can use products with salicylic acid, but we often recommend them for people with oily skin. No matter what your skin type, it’s important to go slowly when introducing a new product with salicylic acid. We suggest starting 1–2 times per week and increasing the frequency as tolerated.
Allergic reactions. Some medications, including salicylic acid, may cause allergic reactions. Speak with your medical provider before.
Irritation. Other topical treatments such as retinoids may cause irritation when combined with salicylic acid.
Pregnancy. Low salicylic acid is generally considered safe to use during pregnancy, in small amounts. It’s recommended to get your medical provider’s approval.
Other ingredients. Depending on the specific type of acne you’re experiencing, you may see more benefits by using another ingredient in place of salicylic acid.
Kidney disease or liver disease. In rare cases (like very rare!), a severe condition known as salicylate toxicity could occur.
Since many face washes contain salicylic acid, you can use these cleansers as you normally would in the morning or evening. If you’re using salicylic acid as a toner or topical acne treatment, you can use it after washing your face. Remember to use face lotion to help keep dryness and potential irritation away.
Zaenglein, A. L., et al.Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016, February 17).
American Academy of Dermatology. 10 skin care habits that can worsen acne.(n.d.)
Decker, A., & Graber, E. M. Over-the-counter Acne Treatments: A Review. The Journal of clinical and aesthetic dermatology. ( May 2012).
Arif T. Salicylic acid as a peeling agent: a comprehensive review. Clinical, cosmetic and investigational dermatology. (2015).
Mayo Clinic Staff. Salicylic Acid (Topical Route): Side Effects. (2022, February 1).
Chien, A. L., et al. Treatment of Acne in Pregnancy. Journal of the American Board of Family Medicine. (2016).
Madan, R. K., & Levitt, J. A review of toxicity from topical salicylic acid preparations. Journal of the American Academy of Dermatology. (2014).
Leyden, J., et al. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and therapy, (September, 2017).
Zaenglein, A. L., et al.Guidelines of care for the management of acne vulgaris. Ibid.
Papakonstantinou, E., et al. Hyaluronic acid: A key molecule in skin aging. Dermato-endocrinology (2021 July 1).
This article was originally published on September 24, 2020, and updated on June 17, 2022.
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Nicole Hangsterfer, PA-C
Donna McIntyre, NP-BC