Can salicylic acid cause breakouts or purging?

A new salicylic acid product can be followed by more pimples. That can mean your skin is adjusting, or it can mean the product is irritating your skin. The two call for different actions: one asks you to wait, the other asks you to cut back or stop. This guide explains what the sources say about each, how to tell them apart, and when to stop. For the general question of purging from any acne treatment, see skin purging vs a real breakout. For what salicylic acid does, see the hub guide, what salicylic acid does for your skin.

What the sources say about getting worse first

MedlinePlus, the drug information service of the U.S. National Library of Medicine, says of topical salicylic acid: "Your condition may worsen during the first few days of treatment as your skin adjusts to the medication." It also says that at the start of treatment for acne, "your skin may become dry or irritated."

People often call this early worsening "purging." None of the FDA label rules or acne guidelines that Skinli checked use that word for salicylic acid. The time frame also differs from adapalene. The adapalene Drug Facts label says that "during the early weeks of use, your acne may appear to worsen before it improves." For salicylic acid, MedlinePlus says "the first few days."

So if salicylic acid makes your acne look worse, the sources point to a short window at the start. New pimples that keep coming week after week point to another cause.

How irritation leads to breakouts

The American Academy of Dermatology (AAD) describes several ways a routine can cause breakouts, and each can happen with salicylic acid:

• Too many new products. "Trying new acne treatments too often can irritate your skin and cause breakouts," the AAD says on its page of skin care habits. Its page on acne that will not clear adds: "Trying too many products can stress your skin, worsening acne."
• Scrubbing. "Scrubbing can irritate your skin, causing acne to flare." A salicylic acid wash used with a rough cloth or brush combines two irritants.
• Dryness. "When your skin becomes dry, your body makes more oil. The extra oil can clog your pores, which may lead to more breakouts." The AAD lists salicylic acid among acne treatments that "tend to dry and irritate the skin."
• A harsh wash. On oily skin, the AAD says "using a face wash that is too harsh can irritate your skin and trigger increased oil production."

The FDA requires every acne product to warn: "skin irritation and dryness is more likely to occur if you use another topical acne medication at the same time." A salicylic acid wash plus a salicylic acid toner plus a benzoyl peroxide gel is three acne products on the same skin.

Other ingredients in the product

The active ingredient is one line on the label. The rest of the product, and the rest of your routine, can clog pores too. NICE, the UK guideline body, advises people with acne who use moisturizers and sunscreens "to avoid oil-based and comedogenic preparations." Comedogenic means likely to clog pores. The AAD advises choosing products labeled "oil free" and "noncomedogenic."

If you started a new salicylic acid product and a new moisturizer in the same week, you cannot tell which one caused a breakout. That is one reason to add one new product at a time.

Other causes to check

People often blame a new product for every new pimple. Some habits cause breakouts on their own. Check these before you decide salicylic acid is the problem:

• Picking and squeezing. The AAD says popping pimples yourself risks an infection from the bacteria on your hands, and NICE says persistent picking can increase the risk of scarring.
• Sleeping in make-up. The AAD's oily skin page says: "Always remove all makeup before going to sleep."
• Touching your face. The same page says touching your face "can spread dirt, oil, and bacteria from your hands to your face."
• Sweat. The AAD says to wash as soon as possible after sweating, and that sweat under a hat or helmet irritates the skin.
• A new sunscreen or moisturizer. NICE advises avoiding oil-based and comedogenic products.

If one of these changed at the same time as the salicylic acid, fix that first and keep the salicylic acid at a steady pace. Then watch for two more weeks before you decide.

Breakouts on the body

The same rules apply to a salicylic acid body wash on the chest or back. The AAD's back acne page says "Antibacterial soaps, astringents, and abrasive scrubs can worsen acne," and adds "Ditto for loofahs, back brushes, and buff puffs." It advises gentle, fragrance-free products and loose clothing that lets sweat escape. If body acne gets worse after a new wash, stop the scrubbing tools first. The AAD says anyone with deep, painful acne on the back needs a dermatologist's help.

How to tell adjusting from irritation

Use this table as a guide. It combines the timing from MedlinePlus with the signs of irritation from the FDA and MedlinePlus.

Sign	More likely adjusting	More likely irritation or a reaction
When it starts	First few days	Any time, often after adding or increasing a product
Where	Where you already get acne	New areas, or wherever the product touched
What the skin feels like	Normal, or dry	Burning, stinging that lasts, itching
What you see	Pimples like your usual ones	Redness, peeling, rash, swelling
What to do	Keep going as directed	Cut back or stop, see the steps below

Keeping a simple record helps. Write the start date and take a photo in the same light every few days during the first two weeks. The guide how to take acne progress photos shows how.

What to do

If it looks like adjusting. Keep using the product at the same pace. MedlinePlus says it may take "several weeks or longer" to feel the full benefit, and the AAD says to use a product for 6 to 8 weeks before judging it. Its adult acne page is direct about this period: "During this time, don't add another product. Don't stop using the product you started with."

If it looks like irritation. Follow the label: "if bothersome dryness or peeling occurs, reduce application to once a day or every other day." MedlinePlus says you may apply it less often until your skin adjusts. Stop any other acne medicine on the same skin, and stop scrubbing. Add a moisturizer labeled oil free or non-comedogenic. The AAD's oily skin page says to stop the product or use it less often if your skin becomes irritated.

If irritation does not settle. MedlinePlus says to tell your doctor if skin irritation or stinging is severe or does not go away. The FDA's page on BHA products says: "If you use cosmetics with BHAs and experience skin irritation or prolonged stinging, stop using the product and consult your physician."

When to stop right away

Stop salicylic acid and get emergency help for any of these, which MedlinePlus lists as signs of a serious allergic reaction:

• hives or itching
• throat tightness or difficulty breathing
• feeling faint
• swelling of the eyes, face, lips or tongue

Call a doctor right away for confusion, dizziness, extreme tiredness, headache, fast breathing, ringing or buzzing in the ears, hearing loss, nausea, vomiting or diarrhea. MedlinePlus lists these as serious side effects of salicylic acid, and they are also the signs of too much salicylic acid in the body.

Start slowly

A slow start gives your skin time to adjust. The FDA directions start at one application a day because "excessive drying of the skin may occur." MedlinePlus suggests testing a small amount on one or two small areas for 3 days before using the product more widely. Skinli's rule for any acne product is the same: one new product, started slowly, then wait two to three weeks before adding anything else. The guide how to patch test a new skincare product explains the test.

When to see a doctor

See a doctor or dermatologist if new pimples keep coming after the first few weeks, if you have deep, painful lumps, if acne leaves scars, or if your skin changes fast. The AAD says a dermatologist can help when acne has not cleared with treatment you can buy without a prescription.