Alice!

For years I have had acne. People always say to use salicylic acid products to prevent clogged pores. When I use it, though, I end up getting tiny raised bumps all over the area. Is this some type of an allergic reaction? So, instead of salicylic acid, I should use benzoyl peroxide, right? But that only gets rid of zits, it doesn't help with clogged pores. What should I do?

Dear Reader,

Your question's one that many folks with acne may ask. Your description of your reaction could have a number of explanations, including using a concentration that’s too high for your skin, using it too frequently, or having a mild allergic reaction. You may want to speak to a health care provider, such as a dermatologist, to determine the cause or your reaction and to help you find a skin care routine that best suits your needs. However, there are possible solutions to all three of these explanations (more on these later!). Before getting into the potential solutions for your skin, it might be helpful to understand more about salicylic acid.

Salicylic acid helps reduce the number of cells around the follicles of your skin's oil glands. Available in lotions, creams, and pads, the concentrations available over-the-counter market range from 0.5 to five percent — if your irritation is due to using a concentration that's too high for your skin to handle, you might try a version with a lower concentration. Using it as directed to keep pores unclogged without drying out your skin (which can happen with overuse). If your skin gets too dry, your oil glands may compensate and become over stimulated, potentially increasing the oiliness of your skin. Alternatively, your skin could become irritated, potentially resulting in redness and flakiness. In less common circumstances, overuse of salicylic acid may increase your chance of salicylic acid poisoning, which could result in nausea and vomiting. Finally, use of salicylic acid with certain other products might cause severe skin irritation, so unless directed by a health care provider, you may want to avoid using the following with salicylic acid:  

  • Abrasive soaps and cleansers
  • Skin products that contain alcohol
  • Other acne medications, including benzoyl peroxide, resorcinol, sulfur, or tretinoin
  • Drying cosmetics or soap
  • Medicated cosmetics
  • Other skin medications applied topically

As you've discovered with your use of salicylic acid, acne medications can have side effects — such as the tiny bumps on your face. Most side effects tend to go away after continued use. However, if you experience any severe side effects or the red bumps continue appearing, speaking with a medical professional may be wise. If salicylic acid is greatly bothering your skin, you could consider discontinuing use and try another treatment option instead. Time to turn attention to the other option you mentioned: benzoyl peroxide.

Benzoyl peroxide works in two ways: it kills the bacteria that help cause acne, and it has a drying effect that makes it easier to wash away excess oils and dirt. As it does help unclog pores, it might be what you're looking for! Currently, you can find benzoyl peroxide at varying concentrations — including 2.5 percent, 5 percent, and 10 percent. While you may think you need the most concentrated product to achieve the best results, research has shown that the lower concentrations can be as effective as the higher concentrations. This may be particularly appealing as the lower concentrations are less likely to leave you with skin irritations and redness! However, to reduce your likelihood of experiencing negative side effects of benzoyl peroxide, it's highly recommended that you use it instead of your salicylic acid.

If you decide to switch from salicylic acid to benzoyl peroxide, there are a few points to keep in mind. Your skin may be irritated during the first few weeks, and your acne may seem to get worse before it gets better (sometimes referred to as a “purging period”). Also, once you begin using benzoyl peroxide, it may be best to maintain using it to keep your acne away (i.e., not just stopping immediately after the acne disappears). Also, unless your health care provider tells you otherwise, you may want to steer clear of the following while using benzoyl peroxide:

  • Skin products with peeling agents, such as resorcinol, salicylic acid, sulfur, or tretinoin
  • Irritating hair products, such as hair removers
  • Skin products that cause sensitivity to the sun (including ones containing citric acid or spices)
  • Skin products that have a large amount of alcohol such as astringents, shaving creams, or after-shave lotions
  • Abrasive and drying skin products

Finally, refraining from washing or using any other medications on the area you treat with benzoyl peroxide for at least an hour after use is advised. If you're not sure whether salicylic acid or benzoyl peroxide are for you but want to improve your skin, here are some helpful tips for you to consider that could help in your journey towards clear skin:

  • Wash your face twice daily with a gentle cleanser.
  • Use cleansing clothes.
  • Use pore-clearing adhesive pads.
  • Use an oil-free moisturizer.
  • Refrain from using oily cosmetics.
  • Refrain from “picking” or “popping” the acne.
  • Limit touching or rubbing your face with your hands.

It sounds like you've been trying to find the best treatment for your acne for quite some time. While it may be a relief that there are different treatment options available, it can understandably be a frustrating process to determine which product works best for you. To help relieve any stress that may come with this process, you may want to discuss various products and options with a health care provider or dermatologist before beginning any new regimens.

Good luck with establishing a skincare routine that works for you!

Alice!

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