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Salicylic Acid: Pearl E. Grimes
Salicylic Acid: Pearl E. Grimes
Salicylic Acid
Pearl E. Grimes
6
The author has no financial interest in any of the products or equipment mentioned in this chapter.
Contents
6.2 Chemical Background/Properties
6.1 History . . . . . . . . . . . . . . . . . 49
Salicylic acid (ortho-hydroxybenzoic acid) is a
6.2 Chemical Background/Properties . . . 49 beta hydroxy acid agent (Fig. 6.1). It is a lipo-
6.3 Formulations . . . . . . . . . . . . . . 50 philic compound which removes intercellular
6.4 Indications . . . . . . . . . . . . . . . 50 lipids that are covalently linked to the cornified
envelope surrounding cornified epithelioid
6.5 Contraindications . . . . . . . . . . . 50
cells [1]. Due to its antihyperplastic effects on
6.6 Patient Preparation . . . . . . . . . . . 51 the epidermis, multiple investigators have used
6.7 Peeling Technique . . . . . . . . . . . 51 salicylic acid as a peeling agent [2, 3, 4]. Recent-
ly, histologic assessments using salicylic acid
6.8 Post-peeling Care and Complications . 55
peels in hairless mice reported loss of cornified
6.9 Advantages . . . . . . . . . . . . . . . 55 cells followed by activation of epidermal basal
6.10 Disadvantages . . . . . . . . . . . . . 56 cells and underlying fibroblasts. These findings
suggest that salicylic acid peeling can alter the
6.11 Side Effects . . . . . . . . . . . . . . . 56
underlying dermal tissue without directly
6.12 Patient’s Informed Consent . . . . . . 56 wounding the tissue or causing inflammation
References . . . . . . . . . . . . . . . 57 [5]. Salicylic acid has also been shown to have
anti-inflammatory and antimicrobial proper-
ties. When used in combination with benzoic
acid in Whitfield’s ointment, it has fungicidal
properties.
6.1 History
6.5 Contraindications
Table 6.2 Formulations of salicylic acid: salicylic acid
solutions
In general, there are few contraindications to
Salicylic acid Weight of Amount of salicylic acid chemical peeling. Salicylic acid
peel % salicylic acid ethyl alcohol peels are well tolerated in all skin types (Fitz-
powder (g) 95% (cc) patrick’s I–VI) and all racial/ethnic groups.
General contraindications include salicylate
10 10 100
hypersensitivity/allergy; unrealistic patient ex-
20 20 100 pectations; active inflammation/dermatitis or
30 30 100 infection at the salicylic acid peeling site; acute
40 40 100 viral infection; pregnancy; and isotretinoin
50 50 100 therapy within 3–6 months of the peeling pro-
cedure. The author has performed more than
From Draelos [6] 1,000 salicylic acid peels without observing any
Salicylic Acid Chapter 6 51
techniques involve the use of 20 and 30% sali- The author always performs the initial peel
cylic acid in an ethanol formulation. Salicylic with a 20% concentration to assess the patients’
acid peels are performed at 2- to 4-week inter- sensitivity and reactivity. Before treatment, the
vals. Maximal results are achieved with a series face is thoroughly cleansed with alcohol and/or
of three to six peels. acetone to remove oils. The peel is then applied
Fig. 6.3.
a Frosting after salicylic acid.
b Crusting 48 h later.
c Resolution of crusting c
in 3 to 4 days
Salicylic Acid Chapter 6 53
Fig. 6.3.
d Complete clearing
of hypopigmentation
by days 7–10. Note im-
provement in acne
a b
Fig. 6.6a, b. Acne rosacea before and after three salicylic acid peels, moderate improvement