Salicylic Acid

Topical Keratolytic

Salicylic acid is available as a over-the-counter topical treatment. Salicylic acid formulations up to 2% are available in cream, gel, gel mask, liquid, lotion, ointment, pads, soap / cleanser, and solution forms. Higher percentages are sometimes prescribed, but this is rare. 

  • Available forms:

    • Topical treatment: 

      • Cream
      • Gel
      • Gel mask
      • Liquid
      • Lotion
      • Ointment
      • Pads
      • Soap / Cleansers
      • Solution
    • Brand names:

      • Akurza® Cream
      • Akurza® Lotion*
      • Aliclen®
      • Avosil®
      • Clearasil® Ultra Daily Face Wash
      • Drytex®
      • Lupicare®
      • Mediplast® pads
      • Neutrogena® products
      • Noxzema® products
      • Oxy® Clinical Advanced Face Wash
      • Oxy® Maximum Cleansing Pads
      • Palmer’s® Skin Success Acne Cleanser
      • Propa pH® Peel-Off Acne Mask
      • Salex® Cream
      • Salex® Lotion
      • Seba-Clear®
      • Stri-Dex® products
      • Therasoft Anti-Acne®
      • Zapzyt®

        (There are many other brand names available)

        * This brand name is no longer available. 
  • Available in these doses:

    • Cream: ≤2%
    • Gel: ≤5% (above 2% is prescription only)
    • Gel mask: 0.5%
    • Liquid: ≤2%
    • Lotion: ≤2%
    • Ointment: ≤6% (above 2% is prescription only)
    • Pads: ≤2%
    • Soap / Cleansers: ≤2%
    • Solution: ≤2%

Dosing information:

The dose and frequency of use depends on the product, varying from as needed to 3 times per day.

  • Who is it for? 

    • Gender:
      • Males and females
    • Severity of acne:
      • Mild-to-moderate
    • Age:
      • Children of 12 years and older, adolescents, and adults

How to use it:

Salicylic acid is topically applied either on an “as needed” basis or up to three times a day to all acne-affected areas of the skin, and not just on individual pimples themselves. Wash your hands immediately after applying salicylic acid to remove remaining medication. 

Do not apply salicylic acid to large areas of your skin and do not cover the treated skin with a bandage or occlusive dressing (which are air-tight materials, such as kitchen plastic wrap) unless instructed by your physician.

When you start using salicylic acid for the first time, apply a small amount to one or two small test areas on your skin once a day, for 3 days, to see if there is any discomfort or abnormal reaction to the medication. If you do not experience such a reaction, start using salicylic acid as indicated. 

During the first weeks of using salicylic acid, you may experience skin dryness or irritation. It is recommended that you apply salicylic acid once a day in the initial phase of the treatment to avoid irritation or dryness of the skin. You may then gradually increase the frequency once your skin has adjusted to the product. If you have any questions about this, ask your physician. 

It may take several weeks of treatment before improvement of acne is apparent. Acne may get worse the first few days of treatment before it gets better because the skin has to adjust to the medication. If your symptoms do not improve or get worse even after regular application for a few weeks, you may require a different treatment.

Do not get salicylic acid in your eyes, nose, or mouth. If it does get into your eyes, nose, or mouth, wash this area with a generous amount of water for 15 minutes and seek immediate medical attention if there is any irritation. Do not swallow salicylic acid. 

Do not use salicylic acid on red, irritated, or infected skin, or on open wounds.

Use salicylic acid exactly as indicated. The dose of salicylic acid may vary between individuals. Similarly, the quantity of salicylic acid per application, the number of applications per day, the time between doses, and the duration of treatment will depend on the product used. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

  • Cream / Gel / Liquid / Lotion:
    • Apply enough to cover the acne-affected areas with a thin layer, one to three times a day. If severe dryness or peeling occurs, reduce to once a day. 
  • Gel mask:
    • Apply the gel mask (0.5%) on acne-affected areas one to two times a week.
  • Pad:
    • Use the pad to wipe over the acne-affected areas one to three times a day and do not rinse off. If severe dryness or peeling occurs, reduce to once a day. 
  • Soap / Cleansers:
    • Very gently cleanse the skin with the cleanser or soap once or twice a day. Rinse thoroughly with warm water and gently pat dry.  
  • Solution:
    • Use a cotton ball or pad to apply the solution to the acne-affected areas of the skin and do not rinse off. 
    • Apply the solution (0.5% to 2%) one to three times a day. 

Be aware of: 

  • Do not use salicylic acid if you are allergic to salicylic acid or any of the other ingredients in the treatment. Contact your physician immediately if you experience hives, trouble breathing, tightness in the throat, itching, swelling of the eyes, face, lips, or tongue, or feel faint while using salicylic acid-containing products. Before you undergo any medical tests, inform your physician/laboratory staff that you are using salicylic acid.
  • If you are applying salicylic acid, do not use any of the following skin products unless instructed by your physician: abrasive soaps or cleansers, alcohol-containing skin care products, medicated cosmetics, skin-drying soaps or cosmetics, products containing a peeling agent or other topical (acne) medications such as benzoyl peroxide, resorcinol, sulfur, and tretinoin. The use of these products together with salicylic acid may increase the irritation of the skin. 
  • Before using salicylic acid, check the complete list of drug interactions below, to make sure that you do not use salicylic acid along with any of the drugs on the list.
  • Before using salicylic acid, consult your physician about using salicylic acid if you currently suffer from or have ever suffered from skin irritation or infection, diabetes, blood vessel disease, or kidney or liver disease.
  • Salicylic acid may cause salicylate toxicity, which is a rare but very serious condition. It is more likely to occur in children with kidney or liver disease. Contact your physician right away if you have nausea, vomiting, dizziness, loss of hearing, ringing or buzzing sounds in the ears, extreme tiredness or weakness, diarrhea, or psychological problems. 
  • Do not use salicylic acid when you have chicken pox or the flu, unless instructed by your physician. The use of salicylic acid when one of these conditions is present increases the risk of Reye’s syndrome (a rare but very serious condition causing swelling in the brain, confusion, and liver damage), especially in children and teenagers.
  • If you are using salicylic acid and are pregnant or are planning on becoming pregnant, talk to your physician about using salicylic acid during pregnancy.
  • If you are using salicylic acid and are breastfeeding, talk to your physician about using salicylic acid during this period.
  • You can continue your regular diet unless your physician tells you otherwise.
  • Do not share your medication with anyone else. 
  • If you are applying salicylic acid, do not use any of the following skin products unless instructed by your physician: abrasive soaps or cleansers, alcohol-containing skin care products, medicated cosmetics, skin-drying soaps or cosmetics, products containing a peeling agent or other topical (acne) medications such as benzoyl peroxide, resorcinol, sulfur, and tretinoin. The use of these products together with salicylic acid may increase the irritation of the skin. 
  • Before using salicylic acid, check the complete list of drug interactions below, to make sure that you do not use salicylic acid along with any of the drugs on the list.
  • Before using salicylic acid, consult your physician about using salicylic acid if you currently suffer from or have ever suffered from skin irritation or infection, diabetes, blood vessel disease, or kidney or liver disease.
  • Salicylic acid may cause salicylate toxicity, which is a rare but very serious condition. It is more likely to occur in children with kidney or liver disease. Contact your physician right away if you have nausea, vomiting, dizziness, loss of hearing, ringing or buzzing sounds in the ears, extreme tiredness or weakness, diarrhea, or psychological problems. 
  • Do not use salicylic acid when you have chicken pox or the flu, unless instructed by your physician. The use of salicylic acid when one of these conditions is present increases the risk of Reye’s syndrome (a rare but very serious condition causing swelling in the brain, confusion, and liver damage), especially in children and teenagers.
  • If you are using salicylic acid and are pregnant or are planning on becoming pregnant, talk to your physician about using salicylic acid during pregnancy.
  • If you are using salicylic acid and are breastfeeding, talk to your physician about using salicylic acid during this period.
  • You can continue your regular diet unless your physician tells you otherwise.
  • Do not share your medication with anyone else. 

Drug interactions: 

Some drugs interact with salicylic acid and should not be used together with salicylic acid. However, your physician may prescribe other drugs together with salicylic acid which may cause a slight interaction, and in this case precautions are necessary.

Drugs that should not be used with salicylic acid at all are:

  • Ketorolac
Full list of drug interactions (From PubMed and Medline Plus)
  • Abciximab
  • Acebutalol
  • Aceclofenac
  • Acemetacin
  • Acenocoumarol
  • Alacepril
  • Amiloride
  • Amineptine
  • Amitriptyline
  • Amitriptylinoxide
  • Amoxapine
  • Amtolmetin Guacil
  • Anagrelide
  • Anisindione
  • Ardeparin
  • Aspirin
  • Atenolol
  • Azilsartan
  • Azilsartan Medoxomil
  • Bemiparin
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Betamethasone
  • Betaxolol
  • Betrixaban
  • Bisoprolol
  • Bromfenac
  • Budesonide
  • Bufexamac
  • Bumetanide
  • Candesartan
  • Cangrelor
  • Captopril
  • Carteolol
  • Carvedilol
  • Celecoxib
  • Celiprolol
  • Certoparin
  • Chlorothiazide
  • Chlorthalidone
  • Cilazapril
  • Cilostazol
  • Citalopram
  • Clomipramine
  • Clonixin
  • Clopamide
  • Clopidogrel
  • Cortisone
  • Cyclopenthiazide
  • Cyclosporine
  • Dalteparin
  • Danaparoid
  • Deflazacort
  • Delapril
  • Desipramine
  • Desmopressin
  • Desvenlafaxine
  • Dexamethasone
  • Dexibuprofen
  • Dexketoprofen
  • Diazoxide
  • Dibenzepin
  • Diclofenac
  • Dicumarol
  • Digoxin
  • Dipyridamole
  • Dipyrone
  • Diuretics
  • Dothiepin
  • Doxepin
  • Droxicam
  • Duloxetine
  • Edoxaban
  • Enalapril
  • Enoxaparin
  • Eplerenone
  • Epoprostenol
  • Eprosartan
  • Eptifibatide
  • Escitalopram
  • Esmolol
  • Ethacrynic Acid
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Feverfew
  • Floctafenine
  • Flufenamic Acid
  • Fluocortolone
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fosinopril
  • Furosemide
  • Ginkgo
  • Gossypol
  • Hydrochlorothiazide
  • Hydrocortisone
  • Hydroflumethiazide
  • Ibuprofen
  • Iloprost
  • Imidapril
  • Imipramine
  • Indapamide
  • Indomethacin
  • Irbesartan
  • Ketoprofen
  • Labetalol
  • Levobunolol
  • Levomilnacipran
  • Lisinopril
  • Lithium
  • Lofepramine
  • Lornoxicam
  • Losartan
  • Loxoprofen
  • Lumiracoxib
  • Meadowsweet
  • Meclofenamate
  • Mefenamic Acid
  • Melitracen
  • Meloxicam
  • Methotrexate
  • Methyclothiazide
  • Methylprednisolone
  • Methyl salicylate
  • Metipranolol
  • Metolazone
  • Metoprolol
  • Milnacipran
  • Moexipril
  • Morniflumate
  • Nabumetone
  • Nadolol
  • Nadroparin
  • Naproxen
  • Nebivolol
  • Nefazodone
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Nortriptyline
  • Olmesartan
  • Opipramol
  • Oxaprozin
  • Oxprenolol
  • Oxyphenbutazone
  • Paramethasone
  • Parecoxib
  • Parnaparin
  • Paroxetine
  • Pemetrexed
  • Penbutolol
  • Pentopril
  • Pentosan Polysulfate Sodium
  • Pentoxifylline
  • Perindopril
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Pindolol
  • Piroxicam
  • Polythiazide
  • Practolol
  • Pralatrexate
  • Prasugrel
  • Prednisolone
  • Prednisone
  • Probenecid
  • Proglumetacin
  • Propanolol
  • Propyphenazone
  • Proquazone
  • Protriptyline
  • Quinapril
  • Ramipril
  • Reboxetine
  • Reviparin
  • Rofecoxib
  • Sertraline
  • Sibutramine
  • Sotalol
  • Spirapril
  • Spironolactone
  • Sulindac
  • Tacrolimus
  • Tamarind
  • Telmisartan
  • Temocapril
  • Tenofovir Disoproxil Fumarate
  • Tenoxicam
  • Tianeptine
  • Tiaprofenic Acid
  • Ticagrelor
  • Ticlopidine
  • Timolol
  • Tinzaparin
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Torsemide
  • Trandolapril
  • Treprostinil
  • Triamterene
  • Trichlormethiazide
  • Trimipramine
  • Valdecoxib
  • Valsartan
  • Venlafaxine
  • Vilazodone
  • Vorapaxar
  • Vortioxetine
  • Warfarin
  • Xipamide
  • Zofenopril

What if I overdose? 

In case of overdose or if someone swallows salicylic acid, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or cannot be awakened, call 911 at once.

Information can also be found online at https://www.poisonhelp.org/help

Symptoms of overdose may include:

  • Confusion
  • Dizziness
  • Extreme tiredness or weakness
  • Headache
  • Fast breathing
  • Ringing or buzzing in the ears
  • Hearing loss
  • Nausea
  • Vomiting
  • Diarrhea

What if I miss a dose?

As soon as you recall that you have missed a dose, apply the missed dose. However, skip the missed dose if it is almost time for your next dose and continue with your prescribed dosing schedule. Do not increase the quantity or frequency of dosing to make up for the missed dose. 

Storage:

Store your medication in the provided container and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze salicylic acid.

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm

References
  1. Medlineplus.gov. (2018). Salicylic Acid: MedlinePlus Drug Information. [online] Available at:https://medlineplus.gov/druginfo/meds/a607072.html. [Accessed 17 May. 2018].
  2. Ncbi.nlm.nih.gov. (2018). Salicylic Acid. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0045043/. [Accessed 17 May. 2018].
  3. Toxnet.nlm.nih.gov. (2018). Salicylic Acid. [online] Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~0RxBx1:1. [Accessed 17 May. 2018].
  4. Uptodate.com. (2018). Salicylic Acid. [online] Available at: https://www.uptodate.com/contents/topical-salicylic-acid-drug-information?search=salicylic%20acid%20topical&source=search_result&selectedTitle=1~108&usage_type=default&display_rank=1. [Accessed 17 May. 2018].
  5. Epocrates.com. (2018). Salicylic Acid. [online] Available at:https://online.epocrates.com/drugs/588510/Durasal/Monograph. [Accessed 17 May. 2018].