SALICYLIC ACID

Acne is an inflammatory disorder with a high global burden. It is common in adolescents and primarily affects sebaceous gland-rich areas. The clinical benefit of the topical acne treatments azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, and alpha-hydroxy acid is unclear. To assess the effects of topical treatments (azelaic acid, salicylic acid, nicotinamide, zinc, alpha-hydroxy acid, and sulphur) for acne. We searched the following databases up to May 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers. Clinical randomised controlled trials of the six topical treatments compared with other topical treatments, placebo, or no treatment in people with acne. We used standard methodological procedures expected by Cochrane. Key outcomes included participants' global self-assessment of acne improvement (PGA), withdrawal for any reason, minor adverse events (assessed as total number of participants who experienced at least one minor adverse event), and quality of life. We included 49 trials (3880 reported participants) set in clinics, hospitals, research centres, and university settings in Europe, Asia, and the USA. The vast majority of participants had mild to moderate acne, were aged between 12 to 30 years (range: 10 to 45 years), and were female. Treatment lasted over eight weeks in 59% of the studies. Study duration ranged from three months to three years. We assessed 26 studies as being at high risk of bias in at least one domain, but most domains were at low or unclear risk of bias. We grouped outcome assessment into short-term (less than or equal to 4 weeks), medium-term (from 5 to 8 weeks), and long-term treatment (more than 8 weeks). The following results were measured at the end of treatment, which was mainly long-term for the PGA outcome and mixed length (medium-term mainly) for minor adverse events. Azelaic acid In terms of treatment response (PGA), azelaic acid is probably less effective than benzoyl peroxide (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.72 to 0.95; 1 study, 351 participants), but there is probably little or no difference when comparing azelaic acid to tretinoin (RR 0.94, 95% CI 0.78 to 1.14; 1 study, 289 participants) (both moderate-quality evidence). There may be little or no difference in PGA when comparing azelaic acid to clindamycin (RR 1.13, 95% CI 0.92 to 1.38; 1 study, 229 participants; low-quality evidence), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). Low-quality evidence indicates there may be no differences in rates of withdrawal for any reason when comparing azelaic acid with benzoyl peroxide (RR 0.88, 95% CI 0.60 to 1.29; 1 study, 351 participants), clindamycin (RR 1.30, 95% CI 0.48 to 3.56; 2 studies, 329 participants), or tretinoin (RR 0.66, 95% CI 0.29 to 1.47; 2 studies, 309 participants), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). In terms of total minor adverse events, we are uncertain if there is a difference between azelaic acid compared to adapalene (1 study; 55 participants) or benzoyl peroxide (1 study, 30 participants) (both very low-quality evidence). There may be no difference when comparing azelaic acid to clindamycin (RR 1.50, 95% CI 0.67 to 3.35; 1 study, 100 participants; low-quality evidence). Total minor adverse events were not reported in the comparison of azelaic acid versus tretinoin, but individual application site reactions were reported, such as scaling. Salicylic acid For PGA, there may be little or no difference between salicylic acid and tretinoin (RR 1.00, 95% CI 0.92 to 1.09; 1 study, 46 participants; low-quality evidence); we are not certain whether there is a difference between salicylic acid and pyruvic acid (1 study, 86 participants; very low-quality evidence); and PGA wa

Acne vulgaris is a common skin condition characterized by excessive sebum production, inflammation, and compromised skin barrier function. Effective treatments should target both lesion reduction and skin hydration while maintaining tolerability. This study aimed to evaluate the efficacy and tolerability of a salicylic acid-containing gel in reducing sebum levels, improving skin hydration, strengthening the skin barrier, and alleviating acne severity over 21 days. A single-center, prospective clinical trial was conducted on 42 participants (37 females, 5 males, mean age: 25.86 ± 6.69 years) with mild-to-moderate acne (IGA grade 2-3) and oily or combination skin. Participants applied the gel twice daily for 21 days. Sebum levels (Sebumeter SM815), trans-epidermal water loss (TEWL, Tewameter TM Hex), and skin hydration (Corneometer CM825) were measured at multiple time points. Acne severity was assessed using the IGA scale, and self-reported satisfaction surveys were collected. Following the follow-up period, sebum levels decreased by 23.65% (p < 0.05), while skin hydration increased by 40.5% (p < 0.05). TEWL decreased by 49.26% (p < 0.05), indicating enhanced skin barrier function. The IGA score improved by 23.81% (p < 0.001), demonstrating a significant reduction in acne severity. All participants (100%) reported satisfaction with the product, with notable improvements in oil control, acne reduction, and skin texture. The gel was well tolerated, with only 5% of participants reporting mild, transient itching, which resolved without intervention. The salicylic acid-containing gel effectively reduces acne lesions, regulates sebum production, enhances skin hydration, and strengthens the skin barrier, making it a suitable option for acne-prone and sensitive skin. These findings suggest that the gel provides a well-balanced approach to acne treatment by addressing both clinical efficacy and user comfort.

Rosacea is a chronic skin condition that affects millions of people worldwide, and its management continues to pose a significant challenge in dermatology. In this study, we investigated the efficacy and safety of 30% supramolecular salicylic acid (SSA) as a treatment for papulopustular rosacea, with a particular focus on improving skin lesions, reducing persistent erythema, and enhancing skin barrier function. Thirty-four patients diagnosed with papulopustular rosacea were randomly divided into an experimental group treated with 30% SSA and a control group receiving a placebo. Clinical outcomes were evaluated based on lesion reduction rates, investigator severity assessment (ISA) scores, VISIA red area scores, and skin barrier, including trans-epidermal water loss (TEWL), sebum levels, stratum corneum hydration, and pH values. A total of 34 patients were collected for both the experimental and control groups, with no statistical differences in age or disease severity between the groups (p > 0.05). The effective rate was 68.75% in the experimental group (p < 0.01). After treatment, the ISA score was 1.75 ± 0.68 in the experimental group and 2.40 ± 0.83 in the control group, indicating significant improvement (p < 0.05). The improvement rate of the VISIA redness score was 25.1% in the experimental group (p < 0.01). Among the 17 patients who underwent skin barrier function testing. Skin hydration significantly improved on left cheek (p < 0.05), right cheek (p < 0.01), and nose (p < 0.05) after 30% SSA treatment in experimental group. Sebum levels were significantly reduced on both cheeks and forehead (p < 0.05). No statistical differences were observed in other locations. Skin TEWL and pH value showed no changes. 30% SSA reduced papules and pustules in rosacea, improved persistent erythema, and enhanced stratum corneum hydration in the 30% SSA-treated group compared to the placebo group. No significant differences were observed in TEWL and skin pH values between the two groups. Our findings suggest that 30% SSA is an effective and safe option for managing papulopustular rosacea, offering a well-tolerated alternative to traditional treatments.

Chemical peels are widely used for both cosmetic and medical dermatologic indications, but their application in individuals with skin of color (Fitzpatrick skin types IV-VI) requires caution due to the increased risk of pigmentary complications. To assess their safety and efficacy, a comprehensive PubMed review was conducted, identifying 473 studies, seven of which met the inclusion criteria, specifically those articles documenting chemical peels in skin of color populations and reported primary outcomes. Among the seven included studies, five evaluated peels for the treatment of acne and acne scarring, all reporting positive outcomes with minimal adverse effects. One study addressed lichen planus pigmentosus, showing significant clinical improvement, and one highlighted chemical burns resulting from improper use. Overall, superficial peels such as glycolic and salicylic acid show promise for acne and pigmentary disorders with good safety profiles. However, research is limited by small sample sizes, short follow-ups, and underrepresentation of Fitzpatrick skin types IV-VI. Further research is needed to establish standardized protocols, assess deeper peels, and guide equitable, evidence-based care.

We report a case of a six-month-old female infant weighing 4.56 kg who presented with altered mental status, severe metabolic acidosis, and multiorgan dysfunction following chronic use of an over-the-counter topical cream containing salicylic acid. The patient had a longstanding pruritic rash treated at home with multiple daily applications of the same topical salicylic acid-containing cream. She developed symptoms consistent with salicylate toxicity in the absence of known ingestion, confirmed by an elevated serum salicylate concentration. Intensive care was required to manage profound metabolic derangements, hepatic dysfunction, coagulopathy, thrombocytopenia, and hypoalbuminemia with third-spacing. Management included intravenous fluids, calcium gluconate, sodium bicarbonate therapy with urine alkalinization, potassium optimization, and supportive care. Dermatology evaluation raised concern for ichthyosis versus severe atopic dermatitis, and genetic testing was nondiagnostic except for a variant of uncertain significance in SLC27A4. The patient improved without dialysis and was discharged with dermatologic care instructions and close subspecialty follow-up. This case highlights the risk of systemic toxicity from topical salicylates in infants, particularly in the presence of impaired skin barrier function, and underscores the importance of cautious use of over-the-counter topical products in vulnerable pediatric populations.

Onychomycosis is a prevalent nail infection, caused by dermatophytes, leading to nail thickening, discolouration, pain and discomfort. Existing topical therapies show limited efficacy due to poor nail penetration and inadequate drug release at the infection site. Current treatment methods include nail removal or laser therapy. To overcome these limitations, we formulated a Ciclopirox-Salicylic acid incorporated Chitosan lotion with penetration enhancers to eliminate the fungal pathogen from the nail bed. Ciclopirox (CX) exhibits both fungicidal and fungistatic activity by inhibiting fungal DNA, RNA and protein synthesis, while salicylic acid (SA) acts as a keratolytic agent that facilitates drug permeation through the nail layers. Tween-80 and poly ethylene glycol (PEG-400) is used as permeation enhancers to improve drug penetration and prevent drug precipitation, thereby enhancing formulation stability. The prepared lotion was characterized using FE-SEM, FT-IR and rheological analyses. The developed CSL-SA-CX shown effective antifungal activity against Candida albicans and Aspergillus niger. Ex vivo porcine skin and goat nail permeation study demonstrated significantly enhanced ciclopirox permeation compared to commercial formulation. In vivo antifungal activity in Drosophila melanogaster fly model validated the in vivo safety of the developed CSL-SA-CX against C. albicans. Thus, the prepared CSL-SA-CX lotion can be used to treat Onychomycosis as well as a wide range of nail fungal infections.

Advances in biotechnology have enabled highly effective, site-specific topical therapies for skin disease. Particle-based delivery systems can be engineered with tailored physicochemical properties and surface modifications to optimize controlled drug release and skin targeting, potentially improving acne treatment outcomes. To evaluate the effectiveness and tolerability of a retinol plus site-specific salicylic acid-targeted bio-delivery system in 40 Fitzpatrick skin type I-VI patients with moderate-to-severe acne over 12 weeks. Significant improvements were observed across multiple efficacy measures, including expert grading, microbiome analysis, visual imaging, and patient self-assessments. Investigator grading demonstrated a 27.8% reduction in inflamed pustules at 2 weeks and a 68.6% reduction at 12 weeks. Acne nodules improved by 61.1% at 2 weeks, with a 92.2% reduction by week 12. Post-inflammatory hyperpigmentation improved significantly beginning at week 2, with an overall 32.3% improvement at week 12. Microbiome analysis showed a 52% reduction in Cutibacterium acnes levels by week 12. Expert grading revealed no erythema by week 12 and no edema throughout the study period. Patients also reported no significant itching, burning, tingling, or stinging sensations during treatment. Combination therapy with site-specific acne medication and retinol produced significant clinical improvement in acne and post-inflammatory hyperpigmentation while demonstrating excellent tolerability over 12 weeks. &nbsp.

Acne is the most prevalent skin disease globally, with a significant burden and limited therapeutic innovation. Although it has a multifactorial etiology, Cutibacterium acnes (C acnes) overgrowth is a key factor in driving inflammation in acne. Bacteriophages are a novel mechanism that can specifically target C acnes and are found in greater abundance on healthy skin compared to acne-prone skin. To study the safety and efficacy of phages and salicylic acid (SA) in acne, and to analyze their mode of action and effect on microbiome diversity. A randomized double-blind placebo-controlled study was conducted on 90 participants for 8 weeks. Males and females 12 to 35 years old with mild to moderate acne were enrolled in placebo, phage, and phage + SA arms. Clinic visits at baseline, week 4, and week 8 collected safety data, VISIA imaging, lesion counts, IGA scores, and microbiome samples. Phage treatment demonstrated an excellent safety profile. Participants in both phage and phage + SA arms showed significant improvement (P<0.05) over baseline at 8 weeks. Phage application resulted in a statistically significant (P<0.05) decrease of C acnes on the skin compared to placebo. Notably, phage use over 8 weeks significantly increased microbiome diversity, a marker of long-term skin health. This study shows the potential of bacteriophages to be a highly promising modality with a unique mode of action for the treatment of acne. Beyond short-term lesion improvement, phage-induced enhancement of microbiome diversity suggests potential for durable, long-term skin health benefits. &nbsp.

Psoriasis is a chronic, immune-mediated disease affecting the skin. Its prevalence varies by region (0.2-9%), and some patients may develop joint involvement. For mild disease, and as adjuncts in moderate disease, topical therapies remain the foundation of care. Classical agents include topical corticosteroids and vitamin D analogs. Other legacy options (tazarotene, salicylic acid, coal tar, and calcineurin inhibitors) serve as adjuvants with variable efficacy. Recent advances have led to new targeted nonsteroidal topicals such as tapinarof (aryl hydrocarbon receptor agonist) and roflumilast (phosphodiesterase 4 inhibitor). We summarize evidence, propose practical prescribing recommendations for nondermatologists, and position new agents within a steroid-sparing, precision framework. A persistent challenge is affordability, in which high acquisition costs for novel topicals may restrict real-world access unless supported by pricing and reimbursement policies. This work was presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá as a concurrent session.

Integrated skincare (ISC) combines dermocosmetics with medical aesthetic procedures to improve outcomes. However, guidance on selecting appropriate active ingredients across different procedure types and phases remains limited. To provide international guidance on appropriate ISC actives for use with aesthetic procedures. In a simplified Delphi study, 14 experts evaluated 44 actives for use across four procedure categories (ablative energy-based, non-ablative energy-based, non-energy-based procedures with or without skin barrier disruption) at four time points (pretreatment, peri-treatment, aftercare, and follow-up ≥ 1 week post-procedure). The panelists also ranked their top five preferred actives for each procedure category and time point. Ceramides, cholesterol, hyaluronic acid, niacinamide, and peptides were deemed appropriate across all procedure categories and all time points. Azelaic acid, benzoyl peroxide, cysteamine, glycolic acid, hydroquinone, lactic acid, retinoids, and salicylic acid were identified as unsuitable for use on treatment day. Ceramides and hyaluronic acid were highly ranked for pre-treatment, peri-treatment and aftercare, while retinoids and ferulic acid were highly ranked for pretreatment and followup. Vitamin C was ranked in the top 5 across all procedure categories and time points, except at pretreatment for non-energy-based without skin barrier damage. Safety and tolerability are primary considerations when selecting ISC actives. Ingredients with higher irritation potential, such as retinoids and acids, should be avoided during the healing phase (on treatment day and during short-term aftercare) due to risk of irritation, as well as post-inflammatory hyperpigmentation in skin of color.

Retinol and salicylic acid are potent bioactive agents commonly used to treat skin pathologies such as acne, psoriasis, and photodamage. Their combined use offers synergistic therapeutic benefits. However, effective delivery of retinol remains challenging due to its poor aqueous solubility and rapid degradation under physiological conditions. In this study, a dual-delivery microsphere platform based on salicylic acid-derived poly(anhydride-ester)s (SAPAEs) was designed to co-release retinol and salicylic acid in a controlled and pH-responsive manner. Four SAPAE compositions with distinct degradation kinetics were synthesized via melt-condensation polymerization, incorporating different ratios of anhydride and ester linkages through copolymerization. Microspheres with reproducible size (∼10 µm) were formulated using an oil-in-water solvent evaporation method, achieving high salicylic acid loadings (54-77 wt%) via polymer composition and retinol loadings of 0.5-1.5 wt% through physical encapsulation. Thermodynamic predictions of retinol-polymer affinity showed reasonable agreement with experimental retinol loading results. Kinetic models applied to the release profiles confirm a surface-erosion mechanism for polymer degradation and subsequent salicylic acid release, while retinol release was mostly driven by diffusion. Faster release of both bioactive compounds were observed in basic solution. Among the formulations tested, the copolymer containing p-phenylenediacetic acid (PA) as the co-monomeric unit (SAA-co-PA) demonstrated the most controlled dual-release profile, with minimal retinol burst and sustained salicylic acid release. This tunable SAPAE-based microsphere platform offers a promising strategy for synergistic controlled delivery of multiple bioactive for skin pathologies and could be extended to other topical applications.

Facial Verruca plana is a common manifestation of human papillomavirus infection that frequently affects the face of children and adolescents and may be resistant to conventional therapies. Management is particularly challenging in pediatric patients due to lesion persistence, recurrence, and cosmetic concerns that limit the use of destructive modalities. Immunotherapy has emerged as a promising alternative; however, evidence for its use in facial verruca plana remains limited. A 9-year-old girl presented with a more than two-year history of multiple facial verruca plana refractory to standard treatments, including topical tretinoin, salicylic acid, and imiquimod. She had no underlying systemic or immunological disease. Clinical examination revealed numerous flat-topped, skin-colored to slightly erythematous papules diffusely involving the face. Laboratory investigations were unremarkable. Following pediatric consultation and informed consent, a single intramuscular hepatitis B vaccine booster was administered as an off-label immunotherapeutic intervention. Clinical improvement was observed within three weeks, with complete resolution of all lesions by six weeks. No adverse effects were reported, and no recurrence was observed during 10 months of follow-up, with sustained remission at 18 months. Immunotherapeutic approaches promote wart clearance through enhancement of cell-mediated immunity. Previous studies of hepatitis B vaccine immunotherapy have largely focused on common and plantar warts and often required repeated or intralesional administration. In contrast, this case demonstrates complete and sustained resolution of facial verruca plana in a pediatric patient following a single intramuscular dose, suggesting a systemic immunomodulatory effect. Intramuscular hepatitis B vaccination may represent a safe and effective immunotherapeutic option for selected pediatric patients with recalcitrant facial verruca plana. Further controlled studies are required to confirm its efficacy and clinical applicability.

>Verruca vulgaris remains a prevalent dermatologic condition, affecting ∼10% of the population, with a higher incidence in children and immunocompromised individuals. Although professional interventions such as cryotherapy, excision, and laser therapy demonstrate success rates of 60% to 90%, financial limitations and restricted health care access underscore the need for structured, home-based alternatives. The proposed research presents an evidence-based treatment protocol that integrates systematic mechanical debridement with occlusion therapy to enhance wart clearance. The methodology emphasizes precise debridement using fine-grade sandpaper or single-edge razors after hydration, followed by occlusion with duct or electrical tape and adjunctive salicylic acid application. Debridement to the level of pinpoint bleeding improves therapeutic penetration and immune activation, while maintaining safety through strict endpoint recognition and single-use tool precautions. A stepwise algorithm and representative case example illustrate the protocol's feasibility, with observable wart softening, size reduction, and skin line restoration within 6 to 12 weeks. Safety monitoring, hygiene practices, and patient education are emphasized to prevent complications such as infection or nerve injury. This structured approach offers clinicians and patients a reproducible, low-cost, and accessible alternative to conventional in-office procedures, bridging evidence-based dermatologic care with home-based treatment practicality. JOURNAL/aswca/04.03/00129334-202605000-00004/figure1/v/2026-04-14T095130Z/r/image-jpegGENERAL PURPOSE: To demonstrate knowledge of an evidence- and home-based debridement and occlusion treatment protocol to enhance clearance of common warts (verruca vulgaris).TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:Identify patients who are appropriate candidates for a home-based wart treatment protocol.Apply evidence-supported methods for implementing a home-based wart treatment protocol.Apply management strategies to address complications or treatment failure associated with a home-based debridement and occlusion protocol for common warts.

Salicylic acid has been used to treat various skin disorders for more than 2,000 years. The ability of salicylic acid to exfoliate the stratum corneum makes it a good agent for peeling. In particular, the comedolytic property of salicylic acid makes it a useful peeling agent for patients with acne. Once considered as a keratolytic agent, the role of salicylic acid as a desmolytic agent, because of its ability to disrupt cellular junctions rather than breaking or lysing intercellular keratin filaments, is now recognized and is discussed here. Salicylic acid as a peeling agent has a number of indications, including acne vulgaris, melasma, photodamage, freckles, and lentigines. The efficacy and safety of salicylic acid peeling in Fitzpatrick skin types I-III as well as in skin types V and VI have been well documented in the literature. This paper reviews the available data and literature on salicylic acid as a peeling agent and its possible indications. Its properties, efficacy and safety, the peeling procedure, and possible side effects are discussed in detail. An account of salicylism is also included.