Medical uses of salicylic acid explained

Drug Name:Salicylic acid
Tradename:Various trade names
Routes Of Administration:topical
Legal Us:OTC
Bioavailability:low
Cas Number:69-72-7
Unii:O414PZ4LPZ
Atc Prefix:D01
Atc Suffix:AE12
Pubchem:338
Drugbank:DB00936
Chemspiderid:331
C:7
H:6
O:3
Smiles:c1ccc(c(c1)C(=O)O)O
Stdinchi:1S/C7H6O3/c8-6-4-2-1-3-5(6)7(9)10/h1-4,8H,(H,9,10)
Stdinchikey:YGSDEFSMJLZEOE-UHFFFAOYSA-N

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

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

It is on the World Health Organization's List of Essential Medicines.[3] [4] It is also available mixed with coal tar, zinc oxide, or benzoic acid.[5]

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. It comes in a number of different strengths.[5]

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.

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.[10] [11]

History

Dioscorides, in the first century AD, described the use of an extract of what might have been willow bark (a plant he called Itea),[12] 'being burnt to ashes, and steeped in vinegar,'[13] for taking away 'corns and other like risings in the feet and toes.' The active ingredient in this mixture could have been salicylic acid, but it is a modern myth that willow was ever used to ease aches and pains or reduce fevers.[10] [14]

Notes and References

  1. Web site: Salicylic acid topical medical facts . Drugs.com. 15 January 2017. live. https://web.archive.org/web/20170817081856/https://www.drugs.com/mtm/salicylic-acid-topical.html. 17 August 2017.
  2. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . 310 .
  3. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  4. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  5. Book: British national formulary : BNF 69. 2015. British Medical Association. 9780857111562. 814–815, 825, 833. 69.
  6. Grimes PE . The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups . Dermatologic Surgery . 25 . 1 . 18–22 . January 1999 . 9935087 . 10.1046/j.1524-4725.1999.08145.x .
  7. Roberts WE . Chemical peeling in ethnic/dark skin . Dermatologic Therapy . 17 . 2 . 196–205 . 2004 . 15113287 . 10.1111/j.1396-0296.2004.04020.x . 44991940 .
  8. Web site: Beta Hydroxy Acids in Cosmetics . U.S. Food and Drug Administration . Center for Food Safety and Applied Nutrition, Office of Cosmetics and Colors Fact Sheet. 7 March 2000 . 2007-11-23 . https://web.archive.org/web/20071221105752/http://www.cfsan.fda.gov/~dms/cos-bha.html . 2007-12-21.
  9. Web site: O'Connell K, Shepard M, Ormond K, Pergament E . Acne and Pregnancy . Illinois Teratogen Information Service . 2000 . 7 . https://web.archive.org/web/20090111064530/http://www.fetal-exposure.org/ACNE.html . 11 January 2009 . Fetal-exposure.org. . 3 June 2012 .
  10. Madan RK, Levitt J . A review of toxicity from topical salicylic acid preparations . Journal of the American Academy of Dermatology . 70 . 4 . 788–792 . April 2014 . 24472429 . 10.1016/j.jaad.2013.12.005 .
  11. Bosund IN, Erichsen I, Molin N . 1960-10-01. The Bacteriostatic Action of Benzoic and Salicylic Acids.. Physiologia Plantarum. en. 13. 4. 800–811. 10.1111/j.1399-3054.1960.tb08103.x. 1399-3054.
  12. Book: Dioscorides P . Osbaldeston TA . De Materia Medica . 2000 . Ibidis . 12 January 2022 . 0-620-23435-0 .
  13. Book: Gerard J . Of the Willow Tree . Herball, or Generall Historie of Plantes . https://www.exclassics.com/herbal/herbalv50587.htm . 12 January 2022.
  14. Web site: Propatier S . 22 May 2014 . The Mythology of Aspirin . 12 January 2022 . Skeptoid Media, Inc. .