Picking out pregnancy-safe skincare can seem complicated. I have an entire page on pregnancy beauty, dedicated to which skincare ingredients to avoid during pregnancy, breastfeeding, or IVF.
Today is about the safety profile of topical salicylic acid during pregnancy and lactation.
Sebum production may increase during pregnancy due to hormonal changes, resulting in clogged pores and acne.
Besides medications, anyone with acne or prone to acne must follow basic skin care practices as outlined here. At times, following these basic practices can rid you of acne.
Salicylic acid, a beta-hydroxy acid, is everyone’s favorite for acne as it is oil-soluble, allowing it to penetrate deep into your pores, unclog them, and reduce redness. It also has an exfoliative action and this, combined with its pore unclogging action, reduces the chances of further breakouts.
But can you use it when you are pregnant or breastfeeding?
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Concerns with salicylic acid during pregnancy.
Salicylic acid is available as an oral medication (e.g., aspirin) as well as in a topical formulation (skin peels, cleansers, serum, moisturizers)
The ingestion of these oral forms during pregnancy is associated with low birth weight, increased mortality in the perinatal period, bleeding in newborns, prolongation of pregnancy duration and labor, and developmental anomalies in the fetus.
This caution has spread over to the topical formulations as well.
A study carried out on salicylic acid found that a relatively very small amount was absorbed through the skin. Depending on the formulation, up to 25% concentration of topical SA was undetectable.
However, so far, no studies have been carried out in pregnancy on topical use.
Can I use topical salicylic acid during pregnancy?
The American College of Obstetricians and Gynecologists (ACOG) deems over-the-counter topical salicylic acid safe during pregnancy.
Up to 2% topical concentration is safe to treat acne during pregnancy as long as you stay at low concentrations and follow certain other guidelines.
How to use salicylic acid during pregnancy?
The following are some points to consider if you decide to incorporate salicylic acid in your daily skincare routine when pregnant:
1) Do not use it if you are not confident about its safety for your baby.
Various other options can effectively treat your pregnancy acne. Click here to read about pregnancy-safe acne treatment.
2) Do not use it if your treating doctor advises against it.
Due to the lack of data on human test subjects for topical preparations and unfavorable data on oral ones, many doctors are not comfortable prescribing salicylic acid to their pregnant patients. Always follow your treating doctor’s advice.
3) Do not use salicylic acid at a concentration exceeding 2%.
2% or less is the typical strength that is present in most commercially available skincare products. The strength will be mentioned on the product label. The FDA considers salicylic acid in 0.5% to 2% as an active ingredient and mandates that it be mentioned on the product label if salicylic acid is in this range. I have not found the information so far about what if it is below this range.
4) Consider a rinse-on over a leave-on treatment.
Salicylic acid at low concentrations can be adequate for acne as a rinse on treatment, like a cleanser or a facial scrub. Particularly so when used as a maintenance treatment. You can still consider using a leave-on treatment but always use a product with only up to 2% salicylic acid.
Click here for a list of pregnancy-safe salicylic acid cleansers.
5) Do not use on large areas.
Usage on a large area means more absorption of it into your system. Restrict the usage to your face. Many body or back acne body washes and creams have salicylic acid as their active ingredient- these should not be used even at low concentrations over such a large area.
6) Avoid multiple facial product types with salicylic acid.
This can result in severe dryness and skin irritation, and it is not recommended that one use multiple products containing it. Even if you used multiple products with no problem before, caution is advised in pregnancy, as your skin can react differently due to hormonal changes.
If you do add multiple products like a cleanser followed by a lotion, both containing salicylic acid or any other exfoliant, start with the lowest concentration and gradually build it up over a matter of weeks.
7) No peels!
A standard for face or body peels is a 20% to 30% concentration of salicylic acid. Even if applied to a small area, this high concentration can adversely affect the growing fetus.
There are also home peels at lower concentrations- these, too, are a strict no.
Stick to less than 2%, and that too on a small area only.
8) Review your other medications.
Salicylic acid is a very effective and common component of medicine used for the treatment of certain common skin conditions like psoriasis, warts, corns, and dandruff, etc.
If you are on medication for any of these conditions, inform your treating doctor so that they can review and decide if you can continue to use it or not.
Can I use salicylic acid while breastfeeding?
There is a positive association of the oral form (Aspirin) with Reye’s Syndrome, which causes brain and liver damage in children, due to which oral salicylic acid (e.g., aspirin) is typically avoided in children.
However, as with pregnant women, no study on topical salicylic acid has been done on breastfeeding women.
WHO, in its guideline on the safety of topical medicines during lactation, states that salicylic acid is safe for use in lactation, as topical medications are usually not absorbed in a significant amount (Breastfeeding and maternal medication: Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs; Topical Dermatological Drugs; page18)
Overall, topical salicylic acid is generally considered safe to use during lactation.
I advise my patients to stick to a maximum of 2% concentration.
At this stage, I am more comfortable with them using multiple products containing salicylic acid, like a serum and an anti-dandruff shampoo or topical warts and corn medications containing salicylic acid.
(Avoid using multiple facial products containing salicylic acid, as it runs a high risk of irritation)
I do not recommend using face or body peels while lactating.
Take care that your baby does not come in contact with salicylic acid, as it can be highly irritating to a baby’s tender skin, and there is a theoretical risk of absorption toxicity.
Takeaway
- There is no study on the effects of topical salicylic acid on the developing fetus, unlike those on oral formulations, which have shown adverse effects.
- Topical salicylic acid up to 2% concentration is generally considered safe in pregnancy and lactation.
- There are other effective treatments available for pregnancy if one does not want to use salicylic acid while pregnant or breastfeeding.
- Topical salicylic acid is safe to use when breastfeeding, but ensure zero contact with the baby as there is a high risk of irritating the baby’s sensitive skin and a theoretical risk of absorption toxicity.
