Salicylic acid was one of the first active compounds used in modern medicine to treat keratinization and inflammatory skin disorders. It was first extracted from willow bark in the 1800s, and its clinical value was quickly established.
Thanks to salicylic acid, millions of patients with acne, psoriasis, dandruff, calluses, or keratosis pilaris are experiencing significant improvement.
This active ingredient acts on the skin surface and directly affects the hair follicle microenvironment and inflammatory response.
Salicylic acid, with its small molecular structure, mild acidity, and strong keratolytic properties, has become the foundation of many modern dermatological treatment regimens.
Salicylic acid effectively treats skin disorders like acne, warts, psoriasis, and calluses.
Salicylic Acid Beyond Skincare
Salicylic acid is more than just a cosmetic ingredient. It is a beta hydroxy acid (BHA) compound derived from willow bark, with a unique molecular structure that penetrates deeply into the skin's lipid layer. Modern medicine recognizes salicylic acid as an effective dermatological treatment, but its role goes beyond its simple exfoliating function.
From cosmetics to clinical treatment
Salicylic acid has emerged from the cosmetic world to become a real medical weapon. In dermatology, it is applied to specific treatment regimens to control symptoms, support skin recovery, and reduce disease progression.
Wide-ranging mechanism of action
This substance acts as a powerful keratolytic agent, stimulating the shedding of the keratinized epidermis, providing local anti-inflammatory action, and reducing sebum blockage. This effect helps treat hyperkeratosis, seborrheic dermatitis, and chronic conditions such as psoriasis.
Acne Treatment
Acne is a common inflammatory skin condition that involves sebaceous gland dysfunction, follicular hyperkeratinization, and overgrowth of Cutibacterium acnes. Salicylic acid is one of the active ingredients approved by the US Food and Drug Administration (FDA) for treating acne. It can penetrate deep into the sebum-containing pores, directly addressing the root cause of inflammation.
Controlled chemical exfoliation
Salicylic acid helps remove the keratinized layer on the skin's surface, preventing the accumulation of dead cells and sebum, two key factors in acne formation.
Topical anti-inflammatory and sebum regulation
This active ingredient inhibits inflammatory cytokines, soothes acne-prone skin, regulates sebum, reduces surface sebum, and improves the hair follicle's biological environment.
Flexible formulations to meet a variety of acne levels
Salicylic acid is present in many specialized products, from spot treatments and gels to topical patches, providing clear results in mild to moderate acne treatment regimens.
Psoriasis Management
Psoriasis is a chronic inflammatory skin disease characterized by excessive proliferation of keratinocytes and local immune dysfunction. Salicylic acid is an effective keratolytic agent, often used with treatment regimens to reduce the thickness of the scaly plaques and improve the penetration of concomitant topical medications.
Reducing hyperkeratosis and desquamation
Salicylic acid acts directly on the hyperkeratotic epidermis, softening and degrading the accumulated keratin and thereby promoting controlled desquamation. This helps free the skin surface, improve the feeling of itching and burning, and promote the absorption of corticosteroids or calcipotriol.
Applications in shampoos and topical medications
Preparations containing salicylic acid, especially shampoos and creams, are commonly used on the scalp and trunk. They help control hyperkeratosis and maintain stable skin conditions during the maintenance phase of treatment.
Salicylic acid is an essential adjunct in a long-term psoriasis management strategy.
Wart and Corn Removal
Warts and corns are manifestations of localized hyperkeratosis caused by HPV or prolonged mechanical pressure. Salicylic acid, at high concentrations of 17% to 40%, is considered the standard active ingredient in topical treatment due to its ability to disrupt the keratinized structure and stimulate the removal of damaged tissue without damaging the surrounding healthy tissue.
Selective keratolytic, wart structure breakdown
This active ingredient works by softening the stratum corneum, breaking down the dead cell barrier, and facilitating the gradual sloughing of necrotic tissue. This continuous and controlled process helps to shorten the lifespan of warts on the skin.
Application in controlled topical treatment
Salicylic acid is often formulated as a patch, concentrated gel, or spot solution, concentrating the active ingredient on the damaged area. Regular daily repetition increases the effectiveness of destroying the wart core or gradually deflating the callus structure.
This is a popular, safe, and highly autonomous patient treatment method.
Calluses and Corns
Calluses and corns are caused by repeated pressure and friction, thickening the horny layer at the pressure points. Salicylic acid is a commonly used active ingredient in treatment because it can dissolve the thickened skin in a controlled manner, improve the feeling of pain, and support the skin's surface recovery.
Soften and remove the horny layer
Salicylic acid breaks down the protein bonds in the keratin layer, softens the thick tissue and facilitates the natural shedding of each horny layer. This process quickly reduces the thickness of the calloused area, relieves pressure at the pressure point, and restores flexibility to the foot.
Supportive treatment in the podiatry specialty
Podiatrists often prescribe high-concentration salicylic acid patches combined with pressure-relieving pads, which are especially effective in chronic calluses, painful cracks, or injuries related to ill-fitting shoes.
Salicylic acid provides clinically significant results in treating calluses and corns due to its controlled keratolytic action and ability to relieve tissue pressure.
Seborrheic Dermatitis and Dandruff
Seborrheic dermatitis and dandruff are two common manifestations of sebaceous gland dysfunction associated with chronic inflammatory skin reactions. This condition is often concentrated in oily areas such as the scalp, face, and chest, and can recur many times. Salicylic acid is used as a supportive treatment ingredient, helping to clear the horny layer, reduce congestion and improve dermatitis symptoms.
Remove the horny layer and accumulated sebum
Salicylic acid breaks down keratin bonds, promotes desquamation, and cleans dead skin cells on oily skin. This process helps to clear the scalp surface, allowing the skin to recover and reducing itching and discomfort.
Combination of treatments in medical shampoos
Salicylic acid shampoo formulations are often prescribed for seborrheic dermatitis outbreaks. When used regularly, this active ingredient helps control sebum production, reduce scaling, and increase the effectiveness of accompanying antifungal ingredients such as ketoconazole or zinc pyrithione.
Salicylic acid, thanks to its keratolytic and mild local anti-inflammatory properties, plays an essential role in the supportive treatment of seborrheic dermatitis and persistent dandruff.
Ichthyosis and Keratosis Pilaris
Ichthyosis and keratosis pilaris are two chronic skin conditions caused by congenital or acquired disorders of keratinization. The skin becomes dry, rough, scaly, or has small papules on the arms, thighs, and buttocks. Salicylic acid acts as a keratinizing agent, helping to soften the skin, promote keratinization, and significantly improve the skin's appearance.
Promoting keratinization in chronic skin conditions
Salicylic acid penetrates deep into the epidermis, breaks down the accumulation of keratinocytes, helps remove the thick, hard layer of skin, and frees the skin surface. This controlled keratolytic mechanism reduces roughness and improves the overall softness of the damaged skin area.
Application in specialized care creams
Preparations containing salicylic acid combined with urea or lactic acid are often indicated in the supportive treatment of chronic hyperkeratosis. Regular use helps to restructure the stratum corneum, maintain moisture, and minimize persistent roughness.
Salicylic acid is the first choice in the management of benign hyperkeratosis, contributing to improved quality of life and comfort for the patient.
Formulations and Delivery Methods
Salicylic acid is developed in various formulations to optimize treatment efficacy and accessibility to skin lesions. Depending on the treatment goal, application site, and lesion extent, dermatologists choose the appropriate formulation to ensure accurate pharmacokinetics and maximum patient safety.
Topical creams, gels, and solutions
Creams are suitable for dry skin or diffuse lesions. Gels and solutions are quickly absorbed and ideal for the scalp, chest, back, and areas with active sebaceous glands. Each formulation has different penetration properties, determining the speed and depth of action.
Patches, tapes, and powders
For localized hyperkeratotic lesions such as warts and calluses, high concentrations of salicylic acid are formulated as localized patches or powders to isolate the active ingredient in the area to be treated. This form increases contact time and keratolytic efficiency.
OTC and prescription by level
Over-the-counter (OTC) products are typically available in concentrations of 0.5–2%, while prescriptions can be as high as 40%. These products serve specific dermatological indications such as keratoses or persistent warts. Salicylic acid is a versatile active ingredient in terms of route of administration, meeting a variety of modern dermatological treatment needs.
Precautions and Medical Guidance
Salicylic acid is an effective active ingredient in treating many dermatological diseases, but its use should be based on specific clinical assessment to ensure safety and avoid complications. Each skin condition has its own sensitivity and biological response, requiring appropriate medical supervision when used long-term or at high concentrations.
Contraindications in some special cases
Patients with a history of allergies to salicylate derivatives, infants under 2 years of age, and people with widespread open wounds or acute skin irritation should not use salicylic acid. The use should be carefully adjusted in sensitive skin areas such as the genital area, face, or around the eyes.
Monitor skin reactions and systemic absorption
When used over a large area, salicylic acid can be absorbed through the skin and cause systemic toxicity, especially in young children or people with liver and kidney dysfunction. Physicians should monitor for signs of salicylate toxicity, such as tinnitus, dizziness, and nausea.
Consult a specialist before long-term use
A dermatologist should prescribe and monitor preparations containing salicylic acid, especially at high concentrations or in combination with other topical medications, to ensure optimal treatment efficacy and minimize unwanted risks.
Conclusion
Salicylic acid is a classic active ingredient in modern dermatology, with a wide range of applications, from acne, psoriasis, warts, and keratosis pilaris.
The selective keratolytic mechanism, local anti-inflammatory effect, and deep penetration ability create a clear and stable treatment effect.
When used correctly, with appropriate dosage and dosage form, salicylic acid is a safe, flexible, and valuable therapeutic tool in clinical practice.
Frequently Asked Questions (FAQs)
- Does salicylic acid cause thinning of the skin when used long-term? – Using the correct dosage and following professional instructions does not cause skin thinning. However, overuse of high concentrations over a large area can lead to irritation or keratinization disorders.
- Can salicylic acid be used for children? – Children over 2 years old can use salicylic acid at low concentrations and in limited application areas. A dermatologist should assess the indication specifically.
- Does salicylic acid interact with other topical medications? – Salicylic acid can affect the absorption of other topical medications when used simultaneously. There should be a time interval between applications to avoid unwanted side effects.
- How long does it take to see the effect of acne treatment? – Acne treatment effects usually appear after 2–4 weeks of regular use. The response time may vary depending on the severity of acne and the formulation.
- Can salicylic acid be applied to open wounds? – Salicylic acid should not be used on open wounds due to the risk of irritation, systemic absorption, and salicylate toxicity. The skin should be healed before treatment with this active ingredient.
