Why does salicylic acid break me out?

Is it purging or irritation?

Some early worsening is possible as your skin adjusts to salicylic acid. The full benefit can take several weeks or longer. That does not mean every new spot is a purge, or that worsening needs to continue for weeks. Salicylic acid can also cause dryness, irritation and stinging. Reduce frequency if dryness or irritation develops, and do not apply it to skin that is already red, swollen, broken or irritated.14

What else could be causing the breakouts?

• Too much exfoliation can strip away parts of the skin that retain water and healthy fats. Salicylic acid is an exfoliating beta hydroxy acid that reaches into oily pores, making it useful for blackheads and whiteheads, but more exfoliation is not automatically better.
• The whole formula matters. Oily or greasy products, including heavy lotions and creams, can contribute to acne. A product containing salicylic acid is still a complete formula, not just its headline ingredient.
• Frequent product changes can irritate skin and cause new breakouts. Trying several acne products at once can also worsen acne.
• Your acne might need a different approach. Salicylic acid unclogs pores and eases inflammation, but bacteria, oil and other causes can also contribute.

Trying a different product every few days gives the routine plenty of plot twists but very little consistency.2

What should I do now?

1. 1Check the label. The amount, frequency, skin preparation and application method depend on the product. Follow its directions rather than treating a cleanser and a lotion as interchangeable.
2. 2Start cautiously. For first use, apply a small amount to one or two small treatment areas for three days. If there is no reaction or discomfort, use it as directed. Start less frequently if needed and increase only as skin adjusts.
3. 3Remove unnecessary irritants. Avoid abrasive cleansers, alcohol containing products, other exfoliants and medicated products on the same area unless your doctor directs otherwise. This includes benzoyl peroxide and topical retinoids.
4. 4Wash gently with fingertips, up to twice daily and after sweating. Avoid scrubbing tools, irritating toners and astringents.
5. 5Protect your skin outdoors with broad spectrum, water resistant SPF 30 or higher sunscreen. Choose one labeled noncomedogenic, meaning formulated not to clog pores.

A complicated routine is harder to keep up, which is an ambitious design choice for something done before bed.5

How long should I give it?

For acne treatments generally, expect some improvement in four to six weeks if the treatment suits you. Clearing can take two to three months or longer. If there is improvement, continue treatment to help prevent new breakouts. If there is no improvement after four to six weeks, reassess the treatment plan rather than repeatedly replacing products. Follow your dermatologist's plan if you have one.2

When should I stop or get help?

Contact a doctor for moderate or severe irritation, unusually warm skin or flushing. Stop salicylic acid and get immediate medical help for hives, itching, throat tightness, difficulty breathing, faintness or swelling of the eyes, face, lips or tongue. See a dermatologist for deep, painful blemishes that can scar, or acne that has not cleared with nonprescription treatment. Discuss salicylic acid with your doctor before use during pregnancy or breastfeeding, and before combining it with prescription skin treatments.246

Why does hyaluronic acid break me out?

Hyaluronic acid binds water in skin; it is not an exfoliating hydroxy acid. It is usually not irritating, so do not assume new spots are an exfoliation purge. Consider the complete product: heavy or oily formulas can contribute to acne, and even products labeled noncomedogenic can cause breakouts in some people.235