What is salicylic acid? What are the benefits for acne?
Salicylic acid is a beta-hydroxy acid. This is oil soluble which is perfect for acne, as it helps to dissolve the excess oil produced in the pores or oil glands within the skin, as well as break apart the skin cells on the surface which hold the oil or sebum in. Acne is complex, but primarily is it caused by an excess amount of androgens (or male hormone testosterone), which causes an elevated amount of oil or sebum to be produced. This sebum is sluggish, and cannot move out of the pores easily. Combined with this, the skin cells on the surface tend to stick together, causing the sebum to build up. The final piece of the puzzle is that this is the perfect environment for a bacteria known as P. Acnes that thrives in a low oxygen environment.
Salicylic acid combats all this by helping to loosen the skin that blocks the pores and helps to dissolve the sebum or oil, making the environment less attractive to P. acnes.
Is it possible for your skin to be resistant to salicylic acid?
You cannot really be resistant to salicylic acid, but your skin may not benefit if you have dry skin. Most people get confused by the fact that skin can be oily and dry. Believe it or not, this is entirely possible. Sebum or oil sits in the pores located around the hair follicles, and eventually will make its way across the surface of the skin, helping to lubricate it. We all know that water and oil don’t mix, and the skin is no different. Water sits in and around the skin cells. So if you apply salicylic acid over the surface, any oil on the surface will be lost, so that the skin cells are not lubricated or protected from moisture loss, further allowing water to evaporate and cause even more dryness.
It also needs to be remembered that acne is caused by too much oil, too much dead skin sealing in the oil, and the bacteria P.acnes. Salicylic works on the first two, but cannot cause P. Acnes to reduce in numbers, and also does not control the hormones that cause the skin cells and sebum to be produced. So some people may think they are resistant to Salicylic acid, but really it is that their acne cause is stronger than the salicylic effect.
If salicylic acid is not having an effect on your acne, could this mean you’re using the wrong form of salicylic acid?
As discussed, if salicylic acid is not having an effect, we need to look at the androgen hormone levels, as their levels may be too high, causing the sluggish sebum over-production. Commonly the hormone levels can be levelled out with birth control pills.
Additionally the level of P. acnes may also be too high. Sometimes, antibiotics may be prescribed to help reduce the P acnes levels in the skin, thus reducing infection.
P. acnes can be treated in a dermal therapist office with blue LED light therapy, which is non-invasive and a lunch time procedure. There are a number of other options available too.
What is madecassoside? How does it compare to salicylic acid? Does it have any benefits for acne-prone skin?
Madecassoside is a molecule derived from the Centella Asiatica plant found in India. It has anti-inflammatory properties, as it is known as a potent anti-oxidant. There are some studies that show it has great wound healing properties, due to the increase in fibroblast cells seen after its use. It works on a different pathway to Salicylic acid, as it can be used to reduce the inflammation seen in a acneic patient. This means that it helps to speed recovery in the skin after acne. Additionally madecassoside can help reduce hyperpigmentation after acne. Hyperpigmentation is the increased colouring in the skin seen after inflammation, picking or squeezing acne, where the increased colour hangs around for months after the acne has resolved.
What about benzoyl peroxide or tea tree oil?
Benzoyl Peroxide works by reducing and killing bacteria that cause acne, thereby reducing acne itself.Benzoyl Peroxide is available in many different types of products, including washes, creams, gels or pre-moistened cloths, and the concentration will vary greatly between products too. It is important to not use a highly concentrated Benzoyl Peroxide product, as this can irritate the skin. Finally, Benzoyl Peroxide can be used in combination therapy with Salicylic acid or antibiotics, to increase the effectiveness for the patient.
Likewise, Tea tree oil is anti-inflammatory and anti-bacterial in nature. However it is less potent than Benzoyl Peroxide, so typically it is useful in mild cases, as the time frame for effectiveness is higher for tea tree oil. Some people are also allergic to it.
What are some other alternative ingredients to salicylic acid? Could you explain how each ingredient works to fight acne?
Alternative to salicylic acid can also be used. A really great skin care serum is Vitamin A or retinol. There are both over the counter options, like those in skincare, and prescription only products too. Retinol works to unglue the dead skin cells on the surface, by dissolving the connections, or desmosomes, between them. This allows the sebum to escape more efficiently, so that acne levels reduce.
Intense treatment for acne is a prescription retinol called Roaccutane. This is taken as a tablet, and the script usually runs for about 6 months or so. Unless acne is severe, I would not recommend taking Roaccutane, as it completely dries the skin out, and the result of this can be quite uncomfortable. Patients can experience severe dryness, itchy skin, rashes as the skin tries to recover and even spontaneous nose bleeds. I believe that before undertaking this drastic step, alternatives should be explored such as those already discussed.
Incorporating an AHA with your BHA can also be useful. A great combination is lactic acid and salicylic acid, as with this combo, you get the best of both worlds. Lactic acid is water soluble, helping to bring hydration to the skin, loosening dead skin cells and allowing surface debris to be shed. Salicylic acid is oil soluble, further helping by reducing sebum levels to be reduced.
Anything you would like to add?
A great dermal therapist can help guide you on your skincare journey. It is important to note that it may take around 30 days to really notice an improvement in your skin, so patience is key. Professional treatments could include:
Salicylic based chemical peels to have a deeper effect on the skin, really clearing out sebum, and also any build up of dead skin cells. Combination peels that use both AHA and BHA are also highly effective. For example, a jessner peel can effectively help to exfoliate the skin, increase hydration of the skin, and also reduce oil production. Jessner peels can be used around once a month to help clean out the skin, and keep it healthy and blemish free.
Blue LED therapy is a short wavelength of light, that is able to help control and stabilise bacteria that cause acne. Typically treatment with Blue LED lasts only 20 minutes, and is a walk-in, walk-out procedure since there is not pain or negative effects to the skin. The treatment can be undertaken once a week, and there are several studies showing the effectiveness of this non-invasive treatment alone.
Avoid picking pimples or acne spots as this can have long-lasting negative effects. FOr example, if you damage the pore of the skin, the sebum becomes even more firmly trapped, building up a bigger infection within the skin.There is also the possibility of permanent scarring if you create damage to the skin substructure, and this is usually interlaced with hyperpigmentation in response to both the trauma and infection present.
Also avoid over-cleaning. Some people feel that cleansing their face more than twice a day is necessary, but this is making the situation worse. Removing too much oil initiates the skin to produce even more, and can cause an increased amount of blemishes to crop up. It is only necessary to cleanse the skin morning and night, and perhaps use a salicylic based at-home exfoliation once a week. I recommend Societe cleansing boost pads, as these are strong enough to be effective, whilst not over stripping the skin either.
Finally, it is important to speak to a dermal therapist about hair products and makeup you are using. Sometimes the ingredients in there seemingly benign products can cause the pores to clog. Your blemishes may be as simple as cutting out the foundation you are using to cover the blemishes in the first place!
Thanks for reading!