Does Salicylic Acid Help Psoriasis?

Sometimes formulations make symptoms worse

Medically reviewed by Casey Gallagher, MD

Salicylic acid is an active ingredient in many over-the-counter (OTC) topical products, including shampoos, ointments, and creams. It is also known as beta-hydroxy acid and has been used to treat the autoimmune skin condition psoriasis. It is considered a keratolytic (peeling) agent that works by causing the outer layer of skin to shed.

Because of a malfunctioning immune system response, psoriasis causes skin inflammation and skin cells to grow faster than usual. Those skin cells pile on the skin’s surface as patches called skin plaques. Salicylic acid can help soften and lift skin scales and reduce the swelling that leads to psoriatic lesions.

Salicylic acid topicals are not your only options for treating psoriasis. Additional treatments like coal tar topicals and drugs that treat the underlying immune processes that lead to psoriasis can also help.

This article covers the safety of salicylic acid for treating psoriasis, side effects, available options, alternative treatments, and more.

Salicylic Acid for Psoriasis Symptoms: Safe or Unsafe?

Salicylic acid is one of the most used treatments for psoriasis. It has been used as a monotherapy (solo treatment) and in combination with other psoriasis treatments.

Skin

Salicylic acid is a keratolytic agent that works to shed dead skin cells. It also has anti-inflammatory effects and can reduce skin inflammation. By offering these benefits, your skin’s appearance will be improved. This is especially helpful for people with plaque psoriasis.

Plaque psoriasis is the most common type of psoriasis. It is characterized by raised skin plaques. The skin might also be red, itchy, and painful. In addition to reducing inflammation that leads to quick skin cell turnover and helping to clear skin, salicylic acid might also reduce the size and appearance of skin plaques.

Related: Common Signs and Symptoms of Psoriasis

One 2015 Dermatology and Therapy report revealed that salicylic acid alone is enough to treat psoriasis plaques for most people. For more severe psoriasis cases, pairing it with stronger prescription medicines can offer further skin clearing.

The primary reason for treating psoriasis with salicylic acid is the keratolytic effect. Salicylic acid products will only target skin plaques and not the immune processes that lead to skin inflammation and skin cell overgrowth.

If your skin is not clearing or symptoms are severe, your healthcare provider can prescribe systemic medicines to taper down your overactive immune system. Systemic therapies affect either the entire body or specific body systems (i.e., the immune system).

Scalp

When psoriasis affects the scalp, it is called scalp psoriasis. The scalp is one of the most commonly affected body areas in people with psoriasis. It can sometimes be difficult to treat due to challenges in delivering therapy. Even so, treatment is vital for improving quality of life.

Medicated OTC shampoos containing salicylic acid can help treat mild psoriasis. These products may also increase the effectiveness of other topical scalp treatments. Unfortunately, few studies demonstrate salicylic acid's effectiveness in treating scalp psoriasis, and available studies have included only small numbers of participants.

Salicylic acid 6% was evaluated in a small open pilot study of 10 people. Here, there was a significant decrease in scalp skin symptoms. Six of the 10 participants were noted to have completely cleared or almost cleared skin at four weeks.

Another small study of 20 people found those who were treated for three to six weeks with daily 6% salicylic acid saw significant scalp clearing from psoriasis scales.

Adding coal tar allowed further skin clearing for study participants with slower or less improvement. As a result, most study participants experienced improved skin, while one even experienced clear skin.

What Is Coal Tar?

Coal tar is a thick liquid that is a byproduct of black coal. It is used in medicated shampoos, soaps, and ointments. It has been found to have antifungal, anti-inflammatory, anti-itch, and antiparasitic properties.

Depending on the severity of psoriatic skin lesions, you should at least see some skin symptom improvement. When applied to the scalp, salicylic acid will break down skin plaques and minimize scalp irritation and itch.

While salicylic acid can cause side effects, it typically will not worsen scalp psoriasis. In rare cases, it is possible to experience skin reactions from higher concentrations that inflame plaques and add further skin inflammation.

Acne

Salicylic acid is also used to treat acne. It seems to work best for mild acne. Acne occurs when hair follicles (pores) become clogged with dead skin cells and oils. This results in blackheads, whiteheads, and pimples on the face and other body areas.

Salicylic acid gets into the skin and works to dissolve dead skin that is clogging your pores. It may take several weeks for the skin to clear, but you should start to see some results within six weeks. If you are not seeing results by then, you should make an appointment with a dermatologist who can diagnose you and suggest treatments that might better help.

Treating Psoriasis With A Dermatologist

A dermatologist is a doctor who specializes in treating nail, skin, scalp, and hair conditions, including psoriasis. This healthcare provider can make a diagnosis, prescribe treatments, and provide suggestions on lifestyle changes. If you think you have psoriasis, reach out to your primary care provider. They can examine your skin and then refer you to a dermatologist.

Once the dermatologist confirms your diagnosis, they will prescribe treatment. After that, you will need regular follow-ups to monitor your symptoms and to assess how treatments are working.

Before making an appointment with a dermatologist, you may want to check with your insurance company to see if the provider is in their network and your insurance will cover the cost of dermatology visits.

How Does Psoriasis Look After Using Salicylic Acid?

Skin treatment goals for treating psoriasis include relieving symptoms like itching, improving skin health by removing scales, and getting skin as clear as possible. According to the National Psoriasis Foundation (NPF), the goal is to reduce psoriasis to 1% of body surface areas (BSA) within three months of starting treatment.

If the 1% result is achieved after three months, you would see your healthcare provider every six months to ensure treatments are still working. If you do not meet the 1% target after three months, your provider will offer additional treatments and reassess your condition in the next three months.

A second treatment recommendation, says the NPF, is “acceptable response.” This means psoriasis covers 3% or less BSA, or you have experienced up to 75% improvement in BSA.

Treating psoriasis with salicylic acid could mean clearer skin. It could also mean less skin dryness (more hydration) and itchiness. Salicylic acid ointment, bath products, and shampoo can clear away dead skin cell flakes and even help reduce skin pain and swelling caused by psoriasis. 

Related: What Does Psoriasis Look Like?

Potential Side Effects

Salicylic acid is safe and gentle for use on most skin types. But like other topicals, it does cause side effects.

Such side effects of salicylic acid include:

• Mild stinging

• Skin dryness

• Skin irritation that could be severe for some people

• Flushing

• Unusually warm skin

• Skin reddening

To avoid irritating healthy skin, keep salicylic acid treatments confined to areas affected by psoriatic lesions. Side effects are common when you first start using topical salicylic acid but should improve over time.

True allergies to topical salicylic acid are rare, although severe reactions have been reported, including anaphylaxis (a severe allergic reaction). Topical salicylic acid poisoning is rare.

Topical salicylic acid may not be a suitable treatment option for children due to side effects. It is not recommended for people with liver or kidney problems and anyone who is pregnant, breastfeeding, or on blood-thinning medicines.

Types of Salicylic Acid for Psoriasis

Salicylic acid is an ingredient in lotions, creams, ointments, shampoos, cosmetics, soaps, toners, and more.

When treating psoriasis with OTC salicylic acid, consider salicylic acid products containing moisturizing ingredients. Salicylic acid can dry out skin, which means it is helpful for oily skin but not so much for psoriasis-affected skin. Salicylic acid products called ceramides can seal moisture in the skin.

Consider the body areas most affected by psoriasis and how you will treat them. You may look for a keratolytic shampoo for scalp psoriasis. Or you may consider a salicylic acid cream or lotion for plaques on your arms and legs.

If symptoms of psoriasis are not responding to OTC salicylic acid topicals, seek help from a dermatologist. Higher strengths can be prescribed to treat psoriasis containing formulations of salicylic acid combined with coal tar, calcineurin inhibitors, and steroids.

You can use topical treatments for as long as you have psoriasis skin plaques. Salicylic acid can help soothe your skin during flares—periods of high disease activity in which skin inflammation and skin cell turnover are high.

You do not need to use salicylic acid topical treatments if your skin is clear, but you want to keep using moisturizers to keep your skin hydrated. Your healthcare provider might also prescribe systemic therapies that keep skin symptoms from occurring in the first place.

Related: When to See a Dermatologist

Ideal Dosage

OTC salicylic acid topical concentrations for treating psoriasis range from 2% to 10%. Higher concentrations can be prescribed and might be more effective in removing scales, but the risk for side effects and adverse reactions is higher.

In some cases, skin reactions from higher concentrations can lead to worsening psoriasis. Your dermatologist can help you find the right concentration for best treating your symptoms. 

How Long to Leave On

You can apply salicylic acid to psoriasis-affected skin based on the product label’s instructions, often once or twice a day. A topical treatment can stay on your skin like other lotions and creams applied to dry skin.

You can use a salicylic acid shampoo every time you shampoo if you have scales. Continue to use the shampoo at least once a week after the scales have cleared.

Make sure you follow the label instructions for salicylic acid products. Do not use more of it or use it more often than recommended. Too much could lead to skin absorption into the bloodstream and lead to salicylic acid poisoning.

Avoid contact with the eyes, nose, and genitals. Do not use on infected or irritated skin areas. Unless your hands are being treated, you should wash them immediately after applying topical medicines.

Long-Term Effects of Treating Psoriasis With Salicylic Acid

The biggest concern with using salicylic acid as a long-term treatment is that it can lead to dry skin and irritation. Dryness and skin irritation can also be reduced by adding a moisturizer like aloe vera gel or shea butter to your salicylic acid skin care routine.

One small 2022 study found mild to moderate psoriasis treated with an OTC gel containing turmeric and salicylic acid, followed by a moisturizer containing shea butter and salicylic acid, improved skin appearance when used daily. Treatment with the gel and moisturizer in this study was once a day for 12 weeks.

Additional concerns with long-term salicylic acid use include skin irritation and skin thinning. Some skin redness and irritation are always possible but can be reduced by following proper application instructions. Salicylic acid softens the outermost layer of skin, removing dead skin cells and flaking, and prolonged use can lead to thinning and loss of skin.

Despite these concerns, salicylic acid can effectively treat psoriatic skin. To avoid severe side effects, salicylic acid should be used sparingly and only when needed. If you have sensitive or dry skin, you may avoid its use entirely and consider other treatments.

Salicylic Acid Alternatives to Try Instead

Salicylic acid is not your only treatment option for managing psoriasis. Your dermatologist can develop a treatment plan tailored to your psoriasis type and specific symptoms. 

Additional treatment options for psoriasis include:

• Steroid creams and nonsteroidal topical medicines: Both types of topicals are available OTC and with a prescription. Topical steroids may help relieve inflammation and itching. Other nonsteroidal topicals like anthralin, synthetic vitamin D3, and vitamin A can help control scaly patches.

• Topical calcineurin inhibitors: Available by prescription, these medicines are sometimes prescribed to treat psoriasis on the face.

• Prescription systemic drugs: These drugs include oral medications, injections, and intravenous infusions that help control the immune processes that lead to psoriasis.

• Phototherapy: Also called light therapy, phototherapy uses ultraviolet (UV) light to help slow skin cell production and reduce inflammation. Treatments can be done at a medical facility or using an at-home light therapy device.

• Oral retinoids: These drugs, derived from vitamin D and available with a prescription, can slow skin turnover and reduce inflammation and swelling.

• Natural options: Examples include oatmeal baths, Epsom salt baths, and aloe vera gel. Colloidal oatmeal or Epsom salt can be added to bathwater to reduce itching and swelling. Aloe vera can keep your skin moisturized and increase skin hydration.

• Coal tar: Coal tar shampoos, soaps, and ointments can slow rapid skin cell growth, reduce swelling and itching, and remove scales.

Related: Topical Treatments for Psoriasis

Quick-Acting Treatments

No single treatment is considered for psoriasis, but some treatments might be quick-acting for reducing skin inflammation and irritation and removing scales.

For example, an Epsom salt or oatmeal bath can soothe skin plaques, help lift scales, and reduce itch immediately. Aloe vera might also offer relief from skin irritation and dryness.

Products containing salicylic acid might also offer a quick way to remove scales when they appear and, when paired with a moisturizer like aloe vera, can offer relief from itch and dryness.

Summary

Salicylic acid is an ingredient in various skin care products, such as lotions, creams, ointments, shampoos, and gels. It has often been used to treat skin affected by psoriasis, an autoimmune skin condition where a malfunctioning immune system leads to quicker-than-average skin cell turnover. That skin overgrowth leads to patches of skin.

Salicylic acid acts as a peeling agent to help shed those extra dead skin cells. It can be prescribed alone or in combination with other therapies.

While salicylic acid can be an effective treatment, it is not your only option. Other OTC topicals like coal tar and steroid creams can also help, as can natural options like oatmeal and Epsom salt baths. Your other options include systemic drugs that control the underlying processes leading to psoriasis skin cell overgrowth and light therapy.

A dermatologist can help you decide whether salicylic acid might help clear your skin. They can also recommend other treatments, including medications, lifestyle therapies, and natural remedies.

Read the original article on Verywell Health.