Medical uses of salicylic acid

Salicylic acid is used as a medicine to help remove the outer layer of the skin.[1] As such it is used to treat warts, calluses, psoriasis, dandruff, acne, ringworm, and ichthyosis.[1][2] For conditions other than warts, it is often used together with other medications.[2] It is applied to the area affected.[1]

Salicylic acid
Cotton pads soaked in salicylic acid for medical use
Clinical data
AHFS/Drugs.comMultum Consumer Information
Routes of
administration		topical
ATC code
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
Chemical and physical data
FormulaC7H6O3
Molar mass138.122 g·mol−1
3D model (JSmol)

Side effects include skin irritation, and salicylate poisoning.[2] Salicylate poisoning tends to only occur when applied to a large area and in children.[2] Use is thus not recommended in children less than two years old.[2] It comes in a number of different strengths.[3]

Salicylic acid has been in medical use since at least the time of Hippocrates.[4] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[5] It is also available mixed with coal tar, zinc oxide, or benzoic acid.[3]

Medical uses

Salicylic acid as a medication is used to help remove the outer layer of the skin.[1] As such it is used to treat warts, calluses, psoriasis, dandruff, acne, ringworm, and ichthyosis.[1][2]

Because of its effect on skin cells, salicylic acid is used in some shampoos to treat dandruff.

In modern medicine, salicylic acid and its derivatives are constituents of some "skin-reddening" products.

Side effects

Concentrated solutions of salicylic acid may cause hyperpigmentation on people with darker skin types (Fitzpatrick phototypes IV, V, VI), without a broad spectrum sunblock.[6][7] Due to sun sensitivity, sun protection is recommended when using salicylic acid on sun-exposed skin.[8]

Pregnancy

No studies examine topical salicylic acid in pregnancy. The risks of aspirin late in pregnancy are probably not relevant for a topical exposure to salicylic acid, even late in the pregnancy, because of its low systemic levels. Topical salicylic acid is common in many over-the-counter dermatological agents and the lack of adverse reports suggests a low risk.[9]

Overdose

Side effects include skin irritation, and salicylate poisoning.[2] Salicylate poisoning tends to only occur when applied to a large area and in children.[2] Use is thus not recommended in children less than two years old.[2] It comes in a number of different strengths.[3]

Salicylic acid overdose can lead metabolic acidosis with compensatory respiratory alkalosis. In people presenting with an acute overdose, a 16% morbidity rate and a 1% mortality rate are observed.[10]

Mechanism of action
See also: Aspirin § Mechanism of action

Salicylic acid works as a keratolytic, comedolytic and bacteriostatic agent, causing the cells of the epidermis to shed more readily, opening clogged pores and neutralizing bacteria within, preventing pores from clogging up again and allowing room for new cell growth.[11][12]

History

Historically salicylic acid is known for its ability to ease aches and pains and reduce fevers.[11] These medicinal properties, particularly fever relief, were discovered in ancient times. It has been also used as an anti-inflammatory drug.[11]

References
  1. "Salicylic acid topical medical facts from Drugs.com". www.drugs.com. Archived from the original on 17 August 2017. Retrieved 15 January 2017.
  2. World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 310. hdl:10665/44053. ISBN 9789241547659.
  3. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 814–815, 825, 833. ISBN 9780857111562.
  4. Boddice, Robert Gregory (2014). Pain and Emotion in Modern History. Springer. p. Chapter 8. ISBN 9781137372437. Archived from the original on 16 January 2017. Retrieved 15 January 2017.
  5. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  6. Grimes, P. E. (1999). "The Safety and Efficacy of Salicylic Acid Chemical Peels in Darker Racial-ethnic Groups". Dermatologic Surgery. 25 (1): 18–22. doi:10.1046/j.1524-4725.1999.08145.x. PMID 9935087.
  7. Roberts, W. E. (2004). "Chemical peeling in ethnic/dark skin". Dermatologic Therapy. 17 (2): 196–205. doi:10.1111/j.1396-0296.2004.04020.x. PMID 15113287. S2CID 44991940.
  8. "Beta Hydroxy Acids in Cosmetics". Archived from the original on 2007-12-21. Retrieved 2007-11-23.
  9. Acne and Pregnancy Archived 2009-01-11 at the Wayback Machine. Fetal-exposure.org. Retrieved on 2012-06-03.
  10. Salicylate Toxicity at eMedicine
  11. Madan RK; Levitt J (April 2014). "A review of toxicity from topical salicylic acid preparations". J Am Acad Dermatol. 70 (4): 788–92. doi:10.1016/j.jaad.2013.12.005. PMID 24472429.
  12. Bosund, I.; Erichsen, I.; Molin, N. (1960-10-01). "The Bacteriostatic Action of Benzoic and Salicylic Acids". Physiologia Plantarum. 13 (4): 800–811. doi:10.1111/j.1399-3054.1960.tb08103.x. ISSN 1399-3054.
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