TABLE OF CONTENTS

It does not matter the age – Acne is ‘no respecter of person.’  While research has shown that it is more prevalent in adolescent years, younger and older adults do face the wrath of breakouts from time to time.  However, many ingredients have been proven effective in fighting this seemingly unwanted foe of the skin, as well as helping to maintain healthy skin. 

Two of the most famous and studied ingredients for acne are Salicylic acid and Benzoyl peroxide.  Both ingredients are prominently placed in many popular skin care products and have proven successful in general.  But is there a difference between these two (2) ingredients? How can they benefit the skin, especially as it relates to acne? Let’s discuss!

The Discussion

Acne vulgaris (the most common form of acne), is a chronic inflammatory condition that mostly affects adolescence and younger age groups (MD, Dr. 2017). However, adults are not immune to acne or the occasional breakouts.

While acne is stated to be a disease of the pilosebaceous unit, it actually develops in the middle part of the sebaceous follicle channel and not in the sebaceous glands as is usually surmised (Aydemir, 2002; James et al., 2008; Gulekon, 1995).  As such, you will mostly see acne on the face, scalp, chest and back as these are mostly where the many sebaceous glands of the skin are located (Aydemir, 2002; Gulekon, 1995).  Therefore, sebum acts as fuel for acne. Hence the reason most treatments are aimed at managing the excretion of sebum (Aydemir, 2002; Plewig and Wolff, 2000).  You can read more about the skin and the sebaceous glands in this post.

• Love the skin you’re in!

The most common pathogenic factors that cause acne formation include the increased production of sebum via the sebaceous gland, alteration in the keratinization process of the skin, bacterial colonization of the follicle and inflammation (Aydemir, 2014). Along with these pathogenic factors, research suggests that other factors can influence acne.  These include one’s diet, hormonal changes, stress as well as environmental elements (Parvin et al. 2008).

While acne vulgaris is denoted as the most common form of this inflammatory disease, other forms include – neonatal acne (acne that develops on a newborn baby’s skin), adult acne (acne that occurs in the adult years), acne cosmetica (acne that occurs after using cosmetic products) and acne mechanica (acne that occurs due to constant pressure, friction, provoked lesions etc.) (Apoorva et al., 2014; Mills & Kligman, 1975).

Acne left untreated or persists for years can affect one’s self-esteem, and emotional well-being, as well as physical issues such as disfigurement and most commonly, scarring (Apoorva et al., 2014).  Research contends that it can lead to depression, and even anxiety (Joseph et al. 2002).  There is no ‘one hat’ that fits all when it comes to the treatment and management of acne.  However, one of the most important parts of the treatment according to research is topical treatment (Aydemir, 2014). 

In this article, we will be exploring two (2) of the most common topical treatments for acne.  These are Benzoyl Peroxide and Salicylic acid.  We will be exploring the benefits of these ingredients for acne, any noted side effects and which is better for your particular acne conditions if any!

Two (2) most used and studied Acne Treatments: 

• Benzoyl Peroxide
• Salicylic Acid

Benzoyl Peroxide and Acne – How does it work?

Benzoyl peroxide is a chemical compound that is used to treat mild to moderate acne inflammatory conditions.  It is one of those over-the-counter topical medications that is approved by the Food and Drug Administration (FDA) for treating acne, particularly, acne vulgaris (Martin & Goodman, 2021).  When used, it has a mild sebostatic as well as a keratolytic effect on the skin (Kircik, 2013).  It is also said to have a mild anti-inflammatory and comedolytic effect on the skin (Patel, 2010; Strauss, 2007).  However, research suggests that it may be more effective when used with other acne vulgaris medications (Kircik, 2013; Zaenglein, 2018).

Once it is absorbed by the skin, benzoyl peroxide is converted to benzoic acid (Nacht et al., 1981).  About five (5%) percent of the absorbed benzoyl peroxide is then absorbed systematically and then excreted by the body’s renal system.  The skin then uses the remaining benzoic acid, which is metabolized by the cysteine in the skin, to help with the oxidization of bacterial proteins (Nacht et al., 1981).  

This entire process then works to improve acne by reducing lipids and free fatty acids as well as what is called ‘Propionibacterium acnes’ (P. acnes) (Nacht et al., 1981).  Propionibacterium acnes (P. acnes) is a gram-positive bacterium that belongs to the skin’s normal flora, oral cavity as well as large intestines etc. (Perry & Lambert, 2011).  As such, it is involved in the pathogenesis of acne and will thus trigger it when it meets favourable conditions (Kirschbaum and Kligman, 1963)

According to Nacht (1983), a ten (10%) percent benzoyl peroxide application for a two (2) week period reduced the (P. acnes) in the hair follicles by Ninety-eight (98%) percent while the amount of the free fatty acids was reduced by half (50%).  These results were comparable to patients who had received antibiotic treatments.  However, the results (antibiotic) were only realized after four (4) weeks (Nacht, 1983).

Benzoyl peroxide was also found to be effective in treating skin or cutaneous ulcers.  This is done by stimulating the healthy production of what is known as ‘granulation tissue’ and the fast growth of epithelium (O’Meara et al., 2001).   Epithelium refers to those cells that line or protect specific organs and glands in the body (Medical Encyclopedia). Further, benzoyl peroxide is usually used without patients developing resistance unlike antibiotic treatments (Kircik, 2013).  However, research suggests that it is more effective when used with a combination of other treatments such as antibiotics or adapalene than using either of these treatments alone (Leyden et al., 2004).

How to use Benzoyl Peroxide

Depending on the product, benzoyl peroxide is usually directed to be used on the acne areas of the skin.  As such, if it is for facial use, it is usually recommended that you wet the face and apply the product accordingly.  You can get benzoyl peroxide both over the counter as well as via a prescription formulation (Hoffman et al., 2018).  The usual concentrations for benzoyl peroxide range from 2.5% to 10% (Hoffman et al. 2018).  As such, you will find it in formulations such as lotions, gels, foams, creams, facial cleansing bars, cleansing lotions or even masks. 

For use, simply follow the instructions on the product package.  Do not leave the product on the skin for an extended period unless it is directed to do so by a Dermatologist or the product instructions.  Remember, as usual, do your patch test to ensure that you are not allergic to the product or will experience any adverse effects.  Even then, still, apply cautiously.

If you are using a tretinoin product, it is best to not use it at the same time as your benzoyl peroxide product. This is because benzoyl peroxide can inactivate tretinoin.  As such, it is recommended that you use the benzoyl peroxide in the morning and the tretinoin product at night (Grobel & Murphy, 2018).

Are there any side effects of using Benzoyl Peroxide?

Benzoyl peroxide may reportedly cause mild dryness of the skin, scarring and even erythema (Foti et al., 2015).  Reports also denote the possible development of contact dermatitis with use, even though it was reportedly a small number of cases.  As such, it is best to discontinue use, if this or even marked erythema occurs (Martin & Goodman, 2021). Erythema is a type of skin rash or a situation where the skin becomes inflamed (red) due to an injury or other inflammatory-triggered conditions (Sciencedirect.com).

Some persons may also experience burning and itching, especially upon initial use or when applied within the first few days.  However, this usually subsides with continuous use (Gollnick, 2003; Sagransky, 2009).  When being applied, it is best to refrain from using it around the mucus membrane (eyes, nose, and mouth) and skin that has been injured.  If this is done, it may cause severe irritation.  In this case, rinse it away with water for at least Fifteen (15) minutes (Matin & Goodman, 2021).

Benzoyl peroxide was also shown to bleach or cause discolouration of coloured fabric.  As such, be mindful of that upon application (Foti et al., 2015).  Also, if you have a known hypersensitivity to benzoyl peroxide, it is best to avoid using it overall (Shwereb & Lowenstein, 2004).

Pregnant women should also avoid using this ingredient as it has been labelled as a ‘pregnancy risk,’ by the Food and Drug Administration (FDA) (Pugashetti & Shinkai, 2013). While there is currently insufficient data as it relates to its effect on one’s reproductive health, one should bear in mind that it does have minimal systemic absorption when applied topically (Pugashetti & Shinkai, 2013). As such, its long-term effect where this is concerned is still not fully established.

Importantly, it is recommended that you use sunscreen as well as limit ultraviolet (UV) exposure when using benzoyl peroxide products as this can lead to phototoxicity/photodamaged skin, which is another unfavourable condition of the skin. Photodamaged skin can lead to premature aging among other skin issues.  You can read more on photodamage/premature aging in these posts:

• Vitamin D and the Skin – Three (3) major benefits worth Knowing!
• Vitamin E and the Skin – Three (3) major Benefits worth Knowing!

Finally, it is not recommended that topical benzoyl peroxide be taken orally (by mouth). If taken by accident, please see your doctor or report to the emergency room immediately.

Salicylic Acid and Acne – How does it work?

Salicylic acid is a naturally occurring substance found in plants such as the willow bark.  The acid belongs to the category of acids known as Beta Hydroxy acids (BHAs) (The American Academy of Dermatology). Like Benzoyl peroxide, salicylic acid is recommended for the treatment of mild or moderate acne, especially as it relates to the cleansing process (Woodruff et al., 2013).  Other than acne, it is said that the ingredient has been used for years (first century AD) to treat many different types of skin disorders such as calluses and corn. This (Arif, 2015).

Salicylic acid can soften and exfoliate the stratum corneum.  The stratum corneum is the outer layer of the epidermis and is the final stage of the maturation and development of the keratinocyte (Murphrey, 2002).  It is also used in topical applications to help with the enhanced absorption of other topical ingredients (Grimes, 2006).

Unlike glycolic acid, which is an alpha hydroxy acid (AHA), salicylic acid is a lipid-soluble agent.  Therefore, it can be mixed with other epidermal and sebaceous gland lipids that are found in the follicles of the hair (Brackett, 1997).  It is also said to possess both keratolytic and comedolytic properties (Draelos, 1997).  As such, like benzoyl peroxide, it also works to decrease the excessive secretion of sebum in acne-prone skin (Arif, 2015).

In a double-blind, placebo-controlled clinical study with over Thirty (30) patients, it was found that just a two (2%) percent salicylic acid facial cleanser for acne was able to significantly reduce acne lesions (Woodruff et al., 2013). This study was conducted with acne patients between the ages of twelve (12) to thirty (30) years, who were suffering from mild to moderate acne vulgaris.  It must be noted that the study was conducted over two (2) weeks.  The study also found that a formulation of that percentage was gentle, non-drying and well-tolerated by the patients.  As such, the researchers contended that this could be a simple approach to treating acne daily.

Salicylic acid was also proven to be an effective peeling agent for patients with acne vulgaris.  This was the conclusion of a study by Marczyk et al. (2014).  In this study, a formulation of both fifty (50%) percent pyruvic acid and thirty (30%) percent salicylic acid was used.  It was proven that salicylic acid had a greater sebumetric effect (anti-acne effect) on the skin than pyruvic acid (Marczyk et al., 2014).  

As such, salicylic acid was able to decrease the adhesion of corneocytes cells, and then detach them (Roberts et al., 1980; Davies and Marks, 1976).  This is one of the main reasons for it being used as a peeling agent by Dermatologists.  It was also found to decrease skin lipids and possess anti-inflammatory properties (Lu et al., 2019).

Research also denoted that salicylic acid is easily absorbed by the skin when applied topically (Adam et al., 2013).  However, its absorption can be enhanced when it is used with hydrophilic-based products (silicones, oil-based products etc.) or maintained under occlusion (Stolar et al., 1960; Taylor & Halprin, 1975).

How to use Salicylic Acid

Like benzoyl peroxide, salicylic acid is usually recommended for mild to moderate acne. You can purchase salicylic acid over the counter as it is often found in cleansers and products geared at treating acne.  As a cleanser, it is typically applied over the entire face.  It can also be used as a spot treatment, but that would be dependent on the product and its instructions.

You can find salicylic acid in varied skin care products in concentrations between 0.5% to 2% (Woodruff et al., 2013).  As such, you will find it in formulations such as lotions, gels, foams, creams, facial cleansing bars, cleansing lotions or even masks.  As such, for general use, try to follow the product’s instructions.

Are there any Side Effects of using Salicylic Acid?

Research has denoted salicylic acid to be safe and well-tolerated by all skin types (Fitzpatrick skin types 1-V and V1.3) (Bourelly & Lotsikas-Baggilim 2005).   However, researchers have reported the occurrence of active dermatitis at the application site (Arif, 2015), as well as mild adverse effects. Additionally, a study by Lee and Kim (2003) with thirty-five (35) patients in Korea who suffered from acne vulgaris reported that some patients (8.8%) developed erythema. 

The erythema lasted for more than two (2) days. Some patients also reported dryness of the skin another noted side effect of the topical application of salicylic acid.  In this study, a salicylic acid peeling solution was used. As such, a moisturizer is always recommended for use with salicylic acid treatments, even if you are using a lower percentage daily.  However, no scarring or prolonged post-inflammatory effect was reported (Grimes, 2006).

It is recommended that persons of darker skin tones exercise caution when using salicylic acid as a chemical peel for acne.  This is because a study by Grimes (1999) found that of the twenty (20) African Americans and five (5) Hispanic participants, sixteen (16%) percent experienced mild side effects which included temporary crusting. Hypopigmentation was also experienced by one (1) patient. However, crusting and hypopigmentation were cleared in a few days. Skin dryness was also observed but was reportedly cleared within two (2) weeks.  As such, the researchers concluded that salicylic acid peels were safe to be used by persons of darker skin tones/ethnicity.

Other noted side effects include intense exfoliation and sensitivity of the skin. As such, it is best to do a patch test and use it with caution, especially if you believe you might have an adverse reaction.  It is also recommended that a moisturizer be used after application as well as sunscreen if the skin is going to be exposed to the sun.

In high concentrations, salicylic acid can be toxic to the nervous system.  This level of toxicity can cause vomiting, nausea, dizziness, psychosis, stupor and even coma which can lead to death (Burke et al., 2006; Lindsey, 1968).  Additionally, the systemic absorption of salicylate can impact glucose metabolism which can lead to hypoglycemia, especially in patients with a condition known as Uremia (Raschke et al. 1991). 

Salicylate is a salt or ester that originates from salicylic acid and is found naturally in some plants, particularly, willow bark leaves (drugs.com).  In addition to using salicylic acid products, one can consume salicylate in other ways as it is used to preserve many foods, added to antiseptic products and even aspirin (drugs.com).

Salicylic acid is not recommended to be used during pregnancy, as its structure is said to be closely related to aspirin (Kinsley et al. 2013).  Aspirin has been linked to miscarriage, birth defects and even bleeding complications (Kinsley et al., 2013). 

Benzoyl Peroxide Vs. Salicylic – Which is Better for Treating Acne?

Based on research, both acids have been recommended for use to treat acne.  However, the one that will be recommended for use will usually be dependent on the medical assessment of your skin. This assessment includes acne conditions such as mild, moderate, and severe.  As such, salicylic acid is usually recommended for the treatment of mild to moderate acne, melasma, photodamaged skin, freckles and lentigines (Arif, 2015).  Additionally, it is recommended to be used for non-inflammatory comedones or mild to moderate inflammatory acne (Strauss, 2007, Thiboutot, 2009).

On the other hand, benzoyl peroxide is usually recommended as the first line of therapy for mild to moderate acne and skin rosacea (Grobel and Murphy, 2018).  The standard application for benzoyl peroxide ranges from two (2%) percent to five (5%) percent for mild to moderate acne (Bojar, 1994; Strauss, 2007).  Nonetheless, dermatologists may recommend other treatments such as antibiotics or a combination of either salicylic acid, benzoyl peroxide or triamcinolone acetate for the treatment of severe acne (inflamed modules and cysts).  (Levin, 1983; Strauss, 2007).

So, which is better? Well, while both are usually recommended to treat mild to moderate acne, comparative studies have shown salicylic acid to be superior to benzoyl peroxide as it relates to reducing acne lesions. In addition, the adverse reactions associated with the use of salicylic acid are said to be usually mild (Zander & Weisman, 1992). Nonetheless, as indicated above, the ingredient that is ultimately recommended will be dependent on one’s skin condition.

 Illustrative Summary

Here is an illustrative summary of Benzoyl Peroxide Vs. Salicylic Acid for the Treatment of ACNE.

Let’s Sum Up!

Acne is a skin condition that can affect anyone.  As such, the condition can arise due to many factors including lifestyle, hormonal changes, the environment and even our diet.  Many treatments are available to manage acne. However, two (2) ingredients that have been among the many and well-researched are salicylic acid and benzoyl peroxide. Both treatments are recommended for the treatment of both mild and moderate acne. However, benzoyl peroxide is usually recommended as the first line of treatment for acne. Nonetheless, for everyday mild acne, salicylic acid is usually recommended.

Whichever is used, will be dependent on the skin condition and the recommendation of a dermatologist, if you should choose to go that route, which would be best, if you are experiencing frequent or severe acne breakouts.  While both treatments can be used alone, they may be recommended to be used together or with other treatments based on the type of acne being experienced.

So, if you are experiencing prolonged acne conditions, apart from dietary or lifestyle changes, you may opt to visit a dermatologist for a treatment plan.  This may include either of the ingredients as explored in this post, or others, based on the condition of your skin.

Have you ever used any of these ingredients? How was it? Share it nuh!  Now, with all that was said,  Are you Skintimate yet?

You can read more about ingredients to fight acne in these articles:

• Lactic acid and the skin.
• Niacinamide – Another Anti-aging Powerhouse – Here are Five (5) Reasons Why!
• Glycolic acid, the Sting of Beauty!
• Beauty is Skin Deep – Here are Five (5) Foods for Beautiful Skin and That Lasting Glow!

Editor’s Note: Article was updated in December 2023.

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