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If you’re one of the 50 million Americans who have acne, you may have heard of salicylic acid and benzoyl peroxide (Oge, 2019). These are two popular acne-fighting medications that can both be purchased over the counter. Which one is better for you? To help you decide, we compare the pros, cons, and side effects of each.
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What is salicylic acid?
Salicylic acid is a beta-hydroxy acid that targets the excess oil (sebum) and dead skin cells that can contribute to acne. Salicylic acid works by exfoliating the skin, preventing comedones (pimples) from forming, and fighting blackheads and whiteheads in the process (Arif, 2015; Sutaria, 2022).
Salicylic acid is a topical acne treatment. When treating acne, salicylic acid can be used both morning and night, up to three times per day. You can find leave-on and wash-off versions of salicylic acid products, with varying concentrations of 0.5% to 2% of the active ingredient (Zaenglein, 2016). Professional chemical peels may use higher concentrations of salicylic acid (Arif, 2015; Sutaria, 2022).
What is benzoyl peroxide?
Benzoyl peroxide works by fighting off P. acnes, the bacteria that causes many types of acne (Matin, 2022). Benzoyl peroxide also encourages excess dead skin cells to slough off, helping restore a more even skin texture (Yang, 2020; Sutaria, 2022). The acne-fighting ingredients in benzoyl peroxide are proven to act quickly, with visible improvement within three weeks of starting treatment (Zaenglein, 2016).
Benzoyl peroxide can be used orally or topically. You can find it in OTC creams, gels, masks, shaving cream, cleansers, and other products containing 2.5% to 10% of the active ingredient. Depending on the product, it can be used once per week or one to three times daily. Benzoyl peroxide is so effective that it’s also available in some prescription acne medications (Matin, 2022).
Benzoyl peroxide has been known to dry out the skin, so you may want to start with a lower concentration and gradually increase it as your skin gets used to it. Along the same lines, when starting to use benzoyl peroxide, you may want to limit yourself to using it once a day. As your skin acclimates, you may increase your use according to the product’s instructions (Leung, 2021).
While salicylic acid primarily acts as an exfoliant, washing away the dead skin cells and oil that clog pores, benzoyl peroxide attacks the acne-causing bacteria itself. Either can be effective depending on your skin concerns and the type of acne you have.
Salicylic acid and benzoyl peroxide side effects
Salicylic acid and benzoyl peroxide are both generally considered safe to use, even during pregnancy (Chien, 2016). However, each comes with its own list of side effects and risk groups that are important to be aware of in case they apply to you (Zaenglein, 2016; Matin, 2022).
Both acne products can dry out and irritate your skin. With benzoyl peroxide, these effects may be more noticeable in the beginning, usually easing once your skin gets used to the medication (Zaenglein, 2016; Leung, 2021).
Salicylic acid side effects
Salicylic acid can have drug interactions with aspirin, corticosteroids, antidiabetes medications, diuretics, and other drugs. If you are taking any medications, talk to your healthcare provider before using a product containing salicylic acid. Common side effects of salicylic acid include (Zaenglein, 2016):
Benzoyl peroxide side effects
Similarly, benzoyl peroxide should not be used with certain medications, including topical tretinoin (see Important Safety Information), sulfone, hydroquinone, or oral isotretinoin. People who are sensitive to cinnamon or benzoic acid should avoid using benzoyl peroxide. Side effects of benzoyl peroxide include (Matin, 2022; Yang, 2020):
Benzoyl peroxide can also bleach your hair and clothes, so you’ll want to thoroughly wash your hands when using this product and be careful about touching dark fabrics (Matin, 2022).
As with any medication, it is possible you may experience an allergic reaction when using salicylic acid or benzoyl peroxide products (Zaenglein, 2016). With benzoyl peroxide, this may show up as contact dermatitis, or a rash. If you develop a rash, stop using the medication and contact your healthcare professional (Matin, 2022). In rare instances, a serious allergic reaction is possible, in which you should seek emergency medical attention immediately (Oge, 2019; Madan, 2014).
People with sensitive skin may want to start with a spot treatment of a low-strength product. To reduce irritation and help increase the effectiveness of these medications, always pair with daily moisturizer and sunscreen (Matin, 2022).
Salicylic acid vs. benzoyl peroxide: which is better?
Deciding which treatment is better for you depends on a number of things, including the type of acne you have, the severity of your breakouts, and your personal medical history and any medications you take. Research suggests benzoyl peroxide is effective at fighting acne, while the research on salicylic acid is limited (Oge, 2019; Zaenglein, 2016).
Both benzoyl peroxide and salicylic acid can be good, over-the-counter options for fighting mild to moderate acne, and they’re generally considered safe. Still, it’s a good idea to consult your healthcare professional for their advice on working these into your skincare routine, to avoid any serious side effects. Be sure to let them know of any medications you are taking, especially topical tretinoin, sulfone, or hydroquinone, or oral isotretinoin (Matin, 2022).
Whether you use salicylic acid or benzoyl peroxide, it takes time for these acne treatments to work. However, if months go by without any noticeable improvement, talk to your healthcare provider about other options, such as oral antibiotics, retinoids, or isotretinoin (Accutane) (Eichenfield, 2021). Some studies show that using benzoyl peroxide with antibiotics or retinoids is more effective than benzoyl peroxide alone (Matin, 2022; Leung, 2021).
- Arif, T. (2015). Salicylic acid as a peeling agent: a comprehensive review. Clinical, Cosmetic and Investigational Dermatology, 8, 455–461. doi:10.2147/CCID.S84765. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26347269/
- Chien, A. L., Qi, J., Rainer, B., et al. (2016). Treatment of acne in pregnancy. Journal of the American Board of Family Medicine, 29(2), 254–262. doi:10.3122/jabfm.2016.02.150165. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26957383/
- Decker, A. & Graber, E. M. (2012). Over-the-counter acne treatments: A review. The Journal of Clinical and Aesthetic Dermatology, 5(5), 32–40. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22808307/
- Eichenfield, D. Z., Sprague, J., & Eichenfield, L. F. (2021). Management of acne vulgaris: A review. JAMA, 326(20), 2055–2067. doi:10.1001/jama.2021.17633. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34812859/
- Leung, A. K., Barankin, B., Lam, J. M., et al. (2021). Dermatology: how to manage acne vulgaris. Drugs in Context, 10, 2021-8-6. doi:10.7573/dic.2021-8-6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34691199/
- Madan, R. K., & Levitt, J. (2014). A review of toxicity from topical salicylic acid preparations. Journal of the American Academy of Dermatology, 70(4), 788–792. doi:10.1016/j.jaad.2013.12.005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24472429/
- Matin, T. & Goodman, M. B. (2022). Benzoyl peroxide. StatPearls. Retrieved on Dec. 5, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK537220/
- Oge, L. K., Broussard, A., & Marshall, M. D. (2019). Acne vulgaris: diagnosis and treatment. American Family Physician, 100(8), 475–484. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31613567/
- Sutaria, A. H., Masood, S., & Schlessinger, J. (2022). Acne vulgaris. StatPearls. Retrieved on Sept. 13, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK459173/
- Yang, Z., Zhang, Y., Lazic Mosler, E., et al. (2020). Topical benzoyl peroxide for acne. The Cochrane Database of Systematic Reviews, 3(3), CD011154. doi:10.1002/14651858.CD011154.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32175593/
- Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–73.e33. doi:10.1016/j.jaad.2015.12.037. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26897386/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.