Topical Salicylic Acid is available as a cream, ointment, liquid, lotion, and scalp solution for the treatment of dandruff, dermatitis, psoriasis, and warts. It is keratolytic and removes the outer layer of the skin (acts as a peeling agent).

Indications of Topical Salicylic Acid:

• Acne:

  • It is indicated for the topical management of acne.

• Dermatitis:

  • Bensal HP:
    • It is used for the treatment of dermatitis-related swelling and irritation, including eczematoid and pyoderma-related complications, treatment of bites of insects, burns, and fungal diseases.

• Hyperkeratotic skin disorders:

  • It works well to remove extra keratin from psoriasis and other skin conditions that affect the scalp, hair, and feet.
  • Treatment and eradication of common and plantar warts

• OTC labeling:

  • Dandruff, psoriasis, or seborrheic dermatitis;
  • removal of warts, calluses, or corns

Topical salicylic acid dose in adults:

Treatment dose of Acne:

• Salicylic acid 0.5% to 2%: OTC labeling: General dosing instructions:

  • The affected area needs to have a thin layer applied 1 to 3 times each day.
  • Due to the potential of excessive drying, products labelled for different daily doses should be begun with 1 dose per day and gradually increased.
  • In cases of dryness or peeling, therapy should be lowered to once daily or every other day.

• Cream, gel, liquid, lotion, pads: Salicylic acid ≤2%:

  • Apply a light coating to the affected area once to three times per day. If dryness develops, lower the frequency to once daily or every other day.

• Cleansers: Salicylic acid ≤2%:

  • Use to cleanse the skin once or twice per day.

• Gel mask: Salicylic acid 0.5%:

  • Use once to twice.

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Topical Salicylic Acid Treatment of Callus and corns: 

Note:

• Soak region in hot water for 5 minutes before applying the item;
• dry the region carefully, then apply medication.

• Gel, liquid: Salicylic acid 13.9 to 17.6%: OTC labeling:

  • Apply one drop to a callus or a full corn, then wait for it to dry.
  • Repeat once or twice daily for up to two weeks until the corn is gone.

• Pads: Salicylic acid 40%: OTC labeling:

  • Apply it immediately to the affected region, and then leave it there for two days.
  • Products can be trimmed with adhesive strips to suit the region or secured.
  • May repeat the operation for up to 14 days every 48 hours as required.

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Topical Salicylic Acid Treatment dose of Dandruff, psoriasis, or seborrheic dermatitis: 

• Cream, gel: Salicylic acid 3%: OTC labeling:

  • It should be applied to the affected area 1-4 times daily.

• Shampoo: Salicylic acid 3%: OTC labeling:

  • When used on wet hair, it should be gently massaged into the scalp before creating a lather and completely rinsing. Use no less than twice each week.

Topical Salicylic Acid Treatment of Dermatitis: 

• Ointment: Salicylic acid 3% (Bensal HP only):

  • Use twice each day.
  • It needs to be reevaluated if an improvement is not noticed after a week.

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Topical Salicylic Acid Treatment dose of Hyperkeratotic skin disorders: 

• Cream, lotion: Salicylic acid 6% (Salacyn):

  • The sKin should be hydrated before the application.
  • Applied daily to the affected area before bedtime.
  • Covering the area is necessary, but avoid using occlusive dressings, garments, or petroleum-based treatments as these can speed up absorption.
  • In the morning, wash off.
  • Occasional use could keep the condition in remission until the affected area is clear.

• Lotion: Salicylic acid 5% (Salitech):

  • applied there and covered up for the night.
  • Before using, gently clean the afflicted region with a cleanser.
  • The application can be repeated in locations where occlusion is challenging or impossible.

• Foam: Salicylic acid 6% (Salvax):

  • Apply twice daily to the afflicted area.

• Gel: Salicylic acid 6% (Keralyt):

  • Before use, skin should be moistened.
  • Daily application, occlude the affected area overnight, and then wash in the morning
  • Occasional use helps keep the condition in remission until the affected area is clear.
  • If you're using the gel on your scalp, wash it off after 10 to 20 minutes at first, but as the therapy goes on, you may need to leave it on for up to an hour.
  • Stay away from normal skin and hair.

• Shampoo:

  • Salicylic acid 6% (Keralyt):

    • It can be applied to the scalp as a concentrated therapy.
    • applied each day to the scalp's trouble spots while the hair is still dry.
    • After five minutes, increase contact duration gradually to one hour.
    • Hair should be properly cleansed with either water or unscented shampoo.
    • Apply daily when hair is still damp to the scalp; work into a lather; let on for a few minutes; and then wash.
    • Occasional use helps keep the condition in remission until the affected area is clear.

  • Salicylic acid 6% (Salex):

    • When the hair is still damp, apply to the scalp; let sit for a bit; then wash.
    • Repeat as necessary.
    • Occasional use will assist in maintaining remission once the affected area gets clear.

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Topical Salicylic Acid Treatment dose of Warts: 

• Liquid, solution: Salicylic acid 26% to 28.5% (Salisol Forte, UltraSal-ER, Virasal): Adults:

  • After 5 minutes of warm water soaking, the wart should be dried.
  • Apply once more after allowing the first application to dry on the entire wart surface.
  • Avoid making touch with the neighbourhood.
  • Keep going to therapy once or twice a day.
  • After 4 to 6 weeks, resolution may be anticipated; some warts may require more time to disappear.

• Liquid: Salicylic acid 17%: OTC labeling:

  • After 5 minutes of soaking in warm water, the wart should be dried.
  • The wart can be covered with one drop.
  • Dry it out.
  • Repeat once or twice daily for up to 12 weeks or until the wart is gone.

• Pads: Salicylic acid 40%: OTC labeling:

  • After 5 minutes of soaking in warm water, the wart should be dried.
  • Directly over the wart, the medicated pad is placed and tightly fastened to the skin.
  • repeated as many times as necessary every 48 hours for up to 12 weeks until the wart is gone.

Topical salicylic acid dose in children:

Topical Salicylic Acid Treatment dose of mild Acne:

• Children aged more than 12 years and Adolescents:

Note:  If it is being used for the first time, apply a modest amount to 1 or 2 minor affected regions for three days to evaluate for sensitivity. If no discomfort arises, according to the usage instructions listed on the label of the specific product.

• • Salicylic acid 0.5% to 2%: General dosing instructions:

    • One to three times per day, a thin layer is applied to the affected area.
    • Products that are marketed for several daily doses should be started with 1 dose daily and increased gradually
    • because excessive dryness can happen 

  • Cream, gel, liquid, lotion, pads: Salicylic acid ≤2%:

    • Apply a small application to the affected region once to three times per day; if dryness or peeling develops, reduce the frequency to once daily or every other day.

  • Cleansers: Salicylic acid ≤2%:

    • Use to cleanse the skin once or twice per day.
    • Use once or twice per week.

  • Gel mask: Salicylic acid 0.5%:

    • Corn or calluses should be covered with one drop, then left to dry.

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Topical Salicylic Acid Treatment dose of Callus and corns: 

• Children and Adolescents:

  • Gel, liquid: Salicylic acid 13.9% to 17.6%:

    • Repeat once or twice everyday for up to 14 days until the corn is gone.

  • Bandages/Discs/Pads/Removers: Salicylic acid 40%:

    • Apply directly over the affected area and leave on for 48 hours.
    • Some products can be trimmed with adhesive strips to suit the region or secured.
    • May repeat the operation for up to 14 days every 48 hours as required.

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Topical Salicylic Acid Treatment dose of Hyperkeratotic skin disorders: 

• Cream, lotion: Salicylic acid 5% or 6%:

  • Children aged more than 2 years and Adolescents:

    • It is applied to the impacted region before bedtime and washed in the morning.
    • Occasional use will retain remission once the impacted region becomes apparent.

• Foam: Salicylic acid 6% (eg, Salvax):

  • Children aged more than 2 years and Adolescents:

    • Apply twice daily to the afflicted area.

• Gel: Salicylic acid 6% (eg, Keralyt):

  • Children aged more than 2 years and Adolescents:

    • Apply it every day, cover the affected area while you sleep, and wash it off in the morning.
    • Once the affected area is visible, occasional use will continue to be remission-free.
    • When applying the gel to the scalp, wash it off after 10 to 20 minutes at first. As the therapy goes on, however, it may be essential to leave it on for up to an hour.

• Topical salicylic acid Shampoo:

  • Children aged more than 2 years and Adolescents:

    • Salicylic acid 6% (Keralyt):

      • Apply daily to impacted regions of the scalp while the hair is dry for use as a focused scalp treatment.
      • It should be left for 5 minutes, which may boost the time of contact to 1 hour gradually.
      • Hair should be washed with water or non-medicated shampoo after therapy.

    • Use as a medicated shampoo

      • It should be applied to wet hair into a lather form and rinsed after a few minutes.
      • Once the impacted region becomes apparent, sometimes use keeps remission.

    • Salicylic acid 6% (Salex):

      • Apply it to wet hair, work it into a lather, and then rinse it off after several minutes.
      • Repeat as necessary.
      • Occasional use will keep the affected area free once the condition has improved.

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Topical Salicylic Acid Treatment dose of Warts: 

• Children and Adolescents:

  • Liquid: Salicylic acid 17%:

    • One drop is used to cover the whole wart and allowed to dry.
    • Repeat once or twice daily until the wart is removed for up to 12 weeks.

  • Bandages/Discs/Pads/Removers: Salicylic acid 40%:

    • Apply medicated pad over the wart and secure firmly to skin.
    • Repeat up to 12 weeks' worth of times per 48 hours until the wart is gone.

Pregnancy Risk Factor C

• Oral administration was shown to have adverse effects on animal reproduction.
• Salicylate can cross the placenta.
• Topical salicylic acid is absorbed systemically. It differs depending upon duration and vehicle. Occlusion increases the rate of absorption.
• Topical salicylates are not recommended during pregnancy for psoriasis treatment due to insufficient data regarding safety and potential systemic absorption.
• Salicylic acid can also be used to treat acne and warts in pregnancy, but only for small areas and for a short time.
• Maternal and fetal adverse effects must be monitored in the event of significant systemic exposure.

Use of topical salicylic acid during breastfeeding

• After taking salicylates by mouth, breast milk may secrete them.
• The length of treatment and the mode of transportation affect salicylate absorption. This rises with occlusion and spans from 9% to 25%.
• Side effects can occur in nursing infants if there is a systemic exposure.
• Breastfeeding mothers can use topical salicylic acid to treat warts.
• To prevent the exposure of the nursing baby, it should not be placed around the breast area.
• The manufacturer suggests that the mother decide whether to stop nursing her infant or if the drug should be continued.
• This decision will depend on how important the mother is to the baby's health.

Dose adjustment in renal disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose adjustment in liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side effects of topical salicylic acid:

• Central nervous system:

  • Dizziness
  • Localized burning (at the site of exposure on normal tissue)
  • Confusion
  • Headache

• Dermatologic:

  • Exfoliation of skin
  • Desquamation

• Local:

  • Localized irritation (at the site of exposure on normal tissue)

• Otic:

  • Tinnitus

• Respiratory:

  • Hyperventilation

Contraindications to Topical Salicylic Acid:

• Hypersensitivity to salicylic acid and any component of the formulation

Additional contraindications

Bensal HP:

• Hypersensitivity to topical Polyethylene Glycols

Keralyt, Salex

• Children under 2 years

UltraSal-ER and Virasal

• Moles, birthmarks, warts on the head or hair growth.
• Diabetes Mellitus
• Inadequate circulation

OTC labeling: Warts/Corns

• Infected, itchy skin
• Moles, birthmarks and warts that have hair growing from them are all known.
• Diabetes mellitus
• Poor blood circulation
• Genital warts or warts on face or mucous membranes.
• There is not much evidence of cross-reactivity between salicylates and allergens. Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.

Warnings and precautions

• Hypersensitivity reaction

  • Topical OTC salicylic Acid-containing products or OTCbenzoyl Peroxide can cause severe allergic reactions or fatal allergic reactions.
  • Hypersensitivity reactions are different from local skin irritation (redness, burning and dryness), which may occur at the product application site. These reactions can be as quick as minutes or days.
  • Therapy should be stopped if there are itching or hives.
  • The active chemicals (benzoyl or salicylic acids) or the inactive ingredient(s), or a mix of both, are probably to blame for this.
  • Contact emergency services right away if you have any serious side effects, such as a sore throat, trouble breathing, nausea, vomiting, or swelling of the face, lips, tongue, or mouth.
  • For three days, apply a tiny amount to the affected area. This will ensure that hypersensitivity symptoms don't develop if you apply OTC topically for the first time.
• Salicylates
  • When topical salicylic acid is coupled with other salicylates or medications that can raise salicylate serum level, toxicity may result.
• Hepatic impairment
  • Patients with severe hepatic impairment who have received long-term therapy or extended use of large areas are likely to experience salicylism.
• Renal impairment
  • Patients with severe renal impairment who are receiving long-term therapy or extended use of large areas may experience salicylism.

Monitoring parameters:

Signs of salicylate toxicity

How to administer Topical Salicylic Acid?

• It is not recommended for use in the eyes, mouth, or vaginal area. Contact with the eyes or mucous membranes should be avoided.
• In the case of excessive peeling or stinging, therapy should be withdrawn. Hands should be washed thoroughly after application.

Keralyt gel:

• Warm water or Keralyt shampoo should be used to remove the hair from the scalp.

Keralyt shampoo:

• The affected parts of the dry scalp should be treated with it, and after five minutes, it should be rinsed off with water or unscented shampoo.
• The length of the treatment should be increased to an hour.
• An alternative is to apply it to damp hair like a medicated shampoo, massage it into a lather, and then rinse it out after a few minutes.

Salvax foam:

• Before using, give it a good shake; depress nozzle to release foam.
• Rub in until all is absorbed.

Bensal HP:

• Rinse the area with water or saline, then pat it dry.
• Apply a thin, continuous layer (about 1/8th inch thick) of the medication with a cotton-tipped applicator either directly to the wound or to a piece of dry gauze that will be placed over it.
• Avoid using wet-to-dry dressings or wet-packs (will dilute ointment and decrease efficacy). For the following three to five minutes, there might be some mild burning.
• When possible, expose the treatment area to air while covering the region with a dressing to protect it from clothing, water, or dirt exposure.

Acne products:

• It should be applied to a greater area of unbroken, clean, and dry skin.
• Creams, gels, and lotions should only be applied thinly to the area that is damaged.
• Cleansing products should be gently massaged into damp skin, built into a lather, and then properly rinsed.
• Apply a thin layer of mask-making ingredients to the face, keeping the mouth and eyes clear.
• After drying, the mask needs to be properly rinsed (turns white).
• Use medicated pads to apply a light layer of salicylic acid to the afflicted regions; do not leave the pad on the skin.
• Bath gels should be massaged over acne-prone skin while in the shower, followed by thorough rinsing.

Corn and callus products:

• Prior to application, the afflicted area should be completely dried after 5 minutes of soaking in warm water.

Wart products:

• The region must first soak in water for five minutes prior to application, and any loose wart tissue must be removed with a brush, washcloth, or emery board before the skin is dried.
• Avoid breathing in fumes when using items in a collodion-like container.

Mechanism of action of Topical Salicylic Acid:

• Salicylic acid is responsible for the dissolution of intercellular cement.
• This leads to desquamation hyperkeratotic epithelium. Salicylic acid can be used to treat keratolytic skin conditions in concentrations between 3% and 6%.
• Warts and corns can be removed with concentrations of 5% to 40%, while acne can be treated with concentrations as high as 2%.

The Onset of action:

• Treatment of warts: 1 to 2 weeks;
• full resolution may take >4 to 6 weeks.

Absorption:

• Gel 6% salicylic acid: >60% (under occlusion). With regular use, systemic toxicity is unlikely to occur.

Protein binding:

• 50% to 80% to albumin

Time to peak, serum:

• Gel with 6% salicylic acid: with occlusion, five hours after application

Excretion:

• Salicylic acid (6%), salicylate glucuronides (42%), and salicyluric acid (52%) are present in urine.

International Brands of Salicylic Acid:

• Bensal HP
• Betasal
• Clear Away 1-Step Wart Remover
• Corn Remover One Step
• Exuviance Blemish Treatment
• Gordofilm; Ionil
• Keralyt Scalp
• Keralyt
• Mediplast
• Neutrogena Oil-Free Acne Wash
• One Step Callus Remover
• P & S Psoriasin
• Sal-Plant
• Salactic Film
• Salacyn
• Salex
• Salicylic Acid Wart Remover
• Salimez
• Salimez Forte
• Salisol
• Salisol Forte
• Salitech
• Salitech Forte
• Salvax
• Scalpicin 2 in 1
• Sebasorb
• Stri-Dex Maximum Strength
• Stri-Dex Sensitive Skin
• Stridex Essential
• UltraSal-E
• Virasal
• Xalix
• Acibath
• Acido Salicilico
• Acnisal
• Adaptoplast
• Anticors Lefebvre
• Bazuka Extra Strength
• Carnation
• Clear Away Wart Removal System
• Clearasil 3 in 1 Deep Cleansing Wash
• Clearasil Spot Control 3 in 1 Exfoliating Cleanser
• Clearasil Spot Control Ice Wash Gel
• Clearasil Spot Control Ice Wash Gel Cleanser
• Clearasil Ultra Deep Pore Cleansing Toner
• Contrheuma
• Coricide le diable
• Corn
• Cross Brand
• Delco Corn Plaster
• Disques coricides
• Duofilm
• Duoplant
• Duoplant Gel
• Egozite Cradle Cap
• Feuille de saule
• Formule W
• Fujin
• Hedera
• Hemozol
• Isocorn
• Kalloplast
• Keranil
• Keranon
• Kerasal
• Koal
• Lygal
• Miniderm
• Occlusal
• Pansements coricides
• Plaster na odciski
• Pommade Mo
• Cochon
• Psorimed
• Saldiam
• Salicid
• Salicilico
• Salicyl
• Salicylix-SF
• Salicylzuur Collodium FNA
• Salicylzuur Hydrogel FNA
• Salicylzuur Zalf FNA
• Salicylzuuroplossing FNA
• Saliderm Gel
• Salidex
• Salikaren
• Salilex Pads
• Salisal
• Salpad
• Salsyvase
• Salva Gel
• Sanitas
• Scholl Corn Removal
• Plasters
• Seal and Heal
• Septisol
• Sicombyl
• Soft Corn
• Sophtal
• Squamasol
• Topisal
• Trans-Ver-Sal
• Transvercid
• Urgo Cor Dressing
• Urgocor Coricide
• Verrugon
• Wart-Off
• Wurzeltod

Topical Salicylic acid Brands Names in Pakistan:

Salicylic Acid Cream 2 % W/W
Movelat	Atco Laboratories Limited

Salicylic Acid Gel 2 % W/W
Movelat	Atco Laboratories Limited

Salicylic Acid Lotion 2 % W/V
Aknonil	Wilshire Laboratories (Pvt) Ltd.