Salicylic Acid for Acne: Treatment Efficacy, Products, Uses, Side Effects

• Salicylic acid is a chemical exfoliative that can effectively treat and prevent acne, particularly noninflammatory acne 
• It can clear pores and prevent dead skin cell, debris and oil buildup
• This acid can be found in a range of over-the-counter, prescription and medical-grade skin care products such as cleansers, toners, gels, moisturizers and peels
• Salicylic acid should not be combined with other exfoliative products as this can cause dryness, redness and possibly burns

Acne is a chronic skin condition that develops when hair follicles become clogged with dirt, dead skin cells and excess sebum (oil). Salicylic acid is a chemical exfoliant that works to clear pores and prevent acne formation by breaking down plugs of sebum and debris, and sloughing off dead skin cells. Salicylic acid for acne has been demonstrated to effectively treat and prevent noninflammatory acne pimples.

What Does Salicylic Acid Do for Your Skin?

Salicylic acid has been used for decades to treat certain skin disorders and for esthetic purposes. 

This acid is known as a desmolytic; it can effectively loosen and break apart the bonds that hold cells together on the outer layer of skin. This promotes exfoliation of dead skin cells, preventing them from accumulating on the surface skin and clogging pores. 

Salicylic acid is a beta-hydroxy acid (BHA) and is therefore oil-soluble. This property enables deep penetration into the follicles to clear oil, dead skin cells and debris, allowing pimples to heal and shrink.

When used at higher concentrations as a light, medium or deep peeling agent, more dramatic results can be achieved. These peels cause a controlled injury, and depending on the strength,  remove one or more layers of skin to reveal the fresh, smooth skin beneath.

Salicylic acid peels can address wrinkles, fine lines, hyperpigmentation and skin laxity. They also stimulate skin cell turnover and boost collagen production to strengthen and thicken skin.

Is Salicylic Acid Effective Against Acne?

Due to its exfoliating properties, salicylic acid is an ideal treatment and preventative against acne. However, while it does offer some benefit for inflammatory acne, it is more effective against noninflammatory (comedonal) acne.

Comedonal acne manifests as blackheads and whiteheads, plugs of debris that block skin follicles. Papules, pustules and cysts are indicative of inflammatory acne, and are a result of a proliferation of the Cutibacterium acnes (formerly Propionibacterium acnes) – Gram-positive bacteria.

While salicylic acid does have antibacterial benefits, it has a greater impact on Gram-negative bacteria. However, salicylic acid can be combined with an antibacterial medication such as benzoyl peroxide to combine the strengths of each for an effective acne-fighting strategy.

Salicylic acid also has antimicrobial properties which does have a moderate degree of efficacy against a range of bacteria, including C. acnes. 

Clinical studies have confirmed that salicylic acid does effectively treat acne when used alone and as part of combination therapy. It reduces redness and inflammation and helps dry up and heal pimples.

A study review of four clinical studies found 0.5% and 2% solutions of salicylic acid reduced the number and severity of acne lesions. Another eight-week study examined the efficacy of a 2% salicylic acid cleanser and found a significant reduction in acne lesions.

Lastly, salicylic acid’s strength in clearing pores enables other acne medications to better absorb into the skin for greater results; importantly, it can also help in antibiotic resistance by replacing short-term antibiotics use with safe, long-term maintenance therapy.

How long does it take to work?

The time it takes to see noticeable results will vary from person to person and depends on a number of factors. These include the severity of the acne, the treatment method and whether they are carried out at home or in a professional setting. Another factor is the strength; it is available OTC from 0.5% to 5% and at higher strengths by prescription.

That being said, with OTC skin care products, you should begin to see small improvements within several days, as your pimples dry out and shrink. It could take up to 12 weeks to see your skin clear completely.

Studies have shown that a cleanser formulated with this acid improved mild-to-moderate acne symptoms in 95% of patients within 4 weeks, when used twice daily,

Professionally administered chemical peels can produce long-lasting and dramatic results after one single treatment. However, they may require up to 4 weeks of downtime depending on the strength of the peel.

Can it treat acne scars?

When used at a 30% strength, salicylic acid is believed to be one of the most effective of chemical peels in the treatment of acne scars. Unlike some other peeling agents, this acid rarely causes postinflammatory hyperpigmentation in darker skin, and is therefore considered a relatively safe acne scar treatment for this group.

Salicylic acid vs. benzoyl peroxide

Salicylic acid has strong exfoliating abilities to clear pores, and while it has modest antibacterial activity, it is not effective in killing C. acnes bacteria. 

Benzoyl peroxide is a staple in acne treatment; in addition to being an exfoliant it has antimicrobial, antibacterial and anti-inflammatory properties. It’s greatest strength is its ability to kill C. acnes bacteria and reduce inflammation.

As such, it is best suited to treat pustules and papules, the lesions characterized by inflammatory acne.

Both ingredients are associated with several mild side effects such as dryness and redness, and are generally not recommended for dry or sensitive skin.

Salicylic Acid Treatments for Acne

Cleansers, face washes, toners or moisturizers formulated with salicylic acid can be used as part of a daily skin care routine to treat and prevent the formation of comedonal acne.

Cleansers and face washes

Cleansers and face washes are among the most common salicylic acid products chosen in acne treatment. Both are gentle enough to use daily, however they differ in terms of potency and which skin types they are best suited for.

Cleansers are typically gentle formulas containing hydrating ingredients, available in the form of gels, creams and lotions; they are designed for normal, dry or sensitive skin.

Face washes contain higher concentrations of active ingredients and usually contain foaming agents; as such, they are designed for oily or combination skin.

Moisturizers

While acne-prone skin tends to be oily, it still requires moisture. Additionally, many acne medications have a drying effect on skin and it is important to replenish this moisture to maintain healthy skin.

Moisturizers containing low-dose salicylic acid cause little irritation, and serve the dual purpose of preventing breakouts by clearing pores and boosting hydration. 

Serums

Depending on your skin type and tolerance, you can choose between 0.5% and 2% salicylic acid serums. Serums are applied to the entire face (avoiding the eye area) after cleansing and toning. 

Spot treatments

Ointments are formulated to be used as spot treatments and typically contain higher concentrations of salicylic acid than other products in the group. The ointment is applied only on the area(s) of active acne.

Toners

Toners are applied after cleansing to remove any remaining residue and rebalance the skin’s pH. Toners containing salicylic acid can be an additional step to ensure your pores remain clear and to enable other acne medications to be more effective through better absorption.

What concentration of salicylic acid is best for acne?

OTC products are available in concentrations ranging from 0.5–5%. It is best to start with a low concentration to reduce the risk of irritating your skin.

Higher concentrations are available by prescription for ointments or medicated pads. Additionally, professional treatments will use medical-grade strength products and up to 30% for chemical peels. 

How to Use Salicylic Acid to Treat Acne

It is important to not use multiple salicylic acid products simultaneously as this can cause dryness, irritation and inflammation. As these products can dry the skin, ensure you follow with a good moisturizer.

Those with oily skin or severe outbreaks can use one product up to twice each day in combination with spot treatments; for dry or sensitive skin, once daily.

For added benefits, opt for a product that contains moisturizing agents such as hyaluronic acid or ceramides; this will prevent your skin from drying out and will support skin health.

Most topical cleansers and toners intended for daily acne management contain a 2% concentration of salicylic acid, suitable for any skin type. Oily skin can tolerate a 5% concentration while those with dry or sensitive skin can choose a low-strength formula designed specifically for these skin types.

Are There Any Side Effects to Using Salicylic Acid?

Salicylic acid is generally considered safe to use, and is well-tolerated by most people with acne. However, there are several mild side effects such as:

• Dryness
• Redness
• Irritation
• Peeling
• Stinging sensation
• Allergic reaction

If used alongside other topical acne treatments, such as retinoids, this could result in excessive irritation.

Can salicylic acid make acne worse?

Overcleansing with salicylic acid can cause the skin to become irritated and inflamed, and this inflammation has the potential to exacerbate acne symptoms and trigger breakouts.

Overuse can strip the skin of its natural oils and cause an overproduction of sebum; this excess oil can clog pores and lead to breakouts.

Takeaway

Salicylic acid is an effective topical acne treatment that is most appropriate for comedonal acne due to its efficacy in breaking down and dissolving whiteheads and blackheads, which are indicative of noninflammatory acne.

This acid is a powerful exfoliant, able to break down the bonds that hold cells together on the outer layer of skin. This effectively sloughs off accumulated dead skin, excess oil, dirt and debris. As a water-soluble acid, it can penetrate deep into follicles to prevent the buildup that results in acne.

Salicylic acid can be used on its own or combined with different acne medications such as benzoyl peroxide for greater benefits. 

To avoid irritating your skin, begin with a low-strength formula and use it once per day; you can gradually increase the frequency and strength once your skin becomes accustomed to the product. Lastly, use just one salicylic acid product at a time to lower the risk of irritation.