Benzoyl peroxide vs salicylic acid: which one is better for acne?

Table of Content:
Similarities & differences | Benzoyl peroxide benefits & side effects | Salicylic acid benefits & side effects | FAQ

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Dr. Iben Miller, dermatologist, says acne is a common skin condition that affects millions of people worldwide. While there are many different topical medications for managing acne, two of the most popular and effective ingredients are benzoyl peroxide and salicylic acid.

Both salicylic acid and benzoyl peroxide are both effective as anti-acne ingredients, but they differ in terms of the effect they have on your skin.

But which one is better for acne? The answer depends a lot on individual preferences, as both ingredients can be effective, depending on your skin type and type of acne lesions that are dominating.

For some people salicylic acid is extremely efficient, while others love the result they get when using benzoyl peroxide, but neither ingredient is clearly more effective at preventing or treating acne.

Whether you prefer the actions of one over the other will depend mostly on what you need from your skincare products and/or specific product formulations.

In this article, we explore the differences between benzoyl peroxide and salicylic acid. From the benefits and drawbacks of each ingredient, we’ll cover everything you and your online dermatologist can make an informed decision about your acne treatment. So whether you’re struggling with persistent breakouts, or simply looking to maintain clear, healthy skin, read on to discover the best acne treatment for you.

If you are interested in learning more about hydroxy acids, you can also read our articles on salicylic and lactic acid, glycolic and lactic acid, glycolic acid and salicylic acid, and glycolic acid and retinol.

Similarities between benzoyl peroxide and salicylic acid

Salicylic acid and benzoyl peroxide are two of the most common ingredients used to combat acne. For both ingredients you can find over-the-counter and prescription-grade formulations. Salicylic acid and benzoyl peroxide can both help reduce the amount of sebum in the skin^[1][2].

Differences between benzoyl peroxide and salicylic acid

Dr. Miller says that the main difference between benzoyl peroxide and salicylic acid is their mechanism of action. Benzoyl peroxide is a bactericidal agent that kills acne-causing bacteria^[3] while salicylic acid is a chemical peel used to exfoliate the skin and unclog pores^[4]. Furthermore, besides being used for acne, salicylic acid is also used to treat melasma, photodamage, freckles, and lentigines^[5]. Benzoyl peroxide is slightly more irritating on the skin than salicylic acid, which is more gentle.

What is benzoyl peroxide and what does it do?

Dr. Miller says that benzoyl peroxide is a topical medication that is FDA-approved for the treatment of acne^[6]. It comes in 2.5%, 5%, and 10% concentrations that can be bought over-the-counter or with a prescription, depending on the product’s concentration.

Benzoyl peroxide acts as a bactericidal agent that kills the C. acnes bacteria and reduces the amount of sebum in the skin^[7].

One of the advantages of benzoyl peroxide is that since it is not an antibiotic, it does not cause drug resistance^[8].

Benzoyl peroxide can be used as lotions, creams, gels, foams, solutions, cleansing bars, cleansing lotions, cloths, pads, masks, and shaving creams.  Benzoyl peroxide and tretinoin are also very effective as a compound medicine for the treatment of moderate to severe acne.

Benefits of benzoyl peroxide

• It can efficiently treat mild acne
• Reduces the amount of sebum in the skin
• Does not cause drug resistance^[9]

Side effects of benzoyl peroxide

• Dry skin
• Redness or peeling
• Burning or stinging^[10]
• Discoloration of clothes and hair (if they come into contact with benzoyl peroxide)
• Photosensitivity

Precautions when using benzoyl peroxide

Benzoyl peroxide should not be used around the eyes, nose, mouth, and open skin as it may cause irritation. If it gets in contact with your eyes or nose, rinse the area thoroughly^[11].

Experts also recommend applying a sunscreen with SPF 50 when using benzoyl peroxide

to decrease the risk of developing phototoxicity and skin irritation^[12].

The effects of benzoyl peroxide on fetal health are unknown. However, the topical application of benzoyl peroxide is generally considered safe during pregnancy^[13].

What is salicylic acid and what does it do?

Dr. Miller says that salicylic acid is a Beta Hydroxy Acid (BHA), which means that it works as an exfoliant since it causes the cells of the outermost layer of the skin to shed, making room for the regrowth of new skin^[14]. In addition to renewing cells, BHA reduces excess sebum and prevents pores from clogging.

Salicylic acid can be used as a lot of different skin care products with lower concentration (approx. 0.5 % to 5%). For example, cleansers, masks, moisturizers, or spot treatment. In dermatological clinics you can also get a stronger chemical salicylic peel with high concentrations of 20% or 30%.

Benefits of salicylic acid

• Prevents dead skin cells and oil from being trapped in the pores^[15]
• It helps remove dead skin cells^[16]
• Reduces the appearance of acne scars^[17] (evidence based on high concentration chemical peels)
• Reduces the post inflammatory hyperpigmentation that may appear after a healed acne lesion (evidence based on high concentration chemical peels)
• Combats inflammation^[18]
• Decreases sebum secretion ^[19]

Side effects of salicylic acid

Although salicylic acid may be considered relatively safe to use, it may cause irritation on the skin at the beginning.

• Crusting
• Dryness
• Skin tingling or stinging
• Itching
• Skin peeling^[20]
• Rare: toxic to the nerve system in high concentrations leading to nausea, vomiting, dizziness, coma

Precautions when using salicylic acid

Avoid applying salicylic acid near the eyes, nose, and mouth. If this occurs, flush immediately with water for 15 minutes. Do not apply salicylic acid on irritated or reddened skin.

Although studies do not show that salicylic acid increases sensitivity to the sun^[22]. It is still considered good practice applying sunscreen with SPF 50 to minimize photoaging and sun damage.

Pregnant women can use low concentrations of products with salicylic acid. However, high-concentration SA chemical peels are teratogenic and are therefore not recommended to pregnant women^{[23] [24]}.

FAQ about benzoyl peroxide and salicylic acid

Can I apply salicylic acid and benzoyl peroxide together?

Dr. Miller recommends using these two products on different days to avoid potential skin irritation. If you do not have sensitive skin or do not experience any skin irritation using benzoyl peroxide and salicylic acid on alternate days, you may try to use salicylic acid in the morning and benzoyl peroxide at night.

How to use both benzoyl peroxide and salicylic acid in the treatment of acne?

It depends on the type of product, for example, there are over-the-counter moisturizers, face washes, cleansers, masks, or chemical peels (performed by a trained healthcare provider).

Dr. Miller recommends that if you want to add salicylic acid as part of your weekly routine skin care at home use a product with a low concentration (0.5-2%) every second or third day in the beginning and see how your skin reacts.

Alternatively, you can get a chemical peel in a clinic with a higher concentration of 20-30% every four weeks depending on your skin condition^[25].

Dr. Miller recommends combining a low concentration of salicylic acid every second or third day alternating with benzoyl peroxide on the days you do not use salicylic acid and start with a product that has a low concentration (2.5%) of benzoyl peroxide and see how your skin reacts.

If you have very sensitive skin, Dr. Miller recommends using a wash-off benzoyl peroxide product instead of a stay-on product. She also recommends sticking only one product with salicylic acid and one benzoyl peroxide to avoid skin irritation and skin dryness, and always applying moisturizer and sunscreen with SPF 50.

Should I use benzoyl peroxide or salicylic acid first?

As a general rule, Dr. Miller does not recommend using benzoyl peroxide and salicylic acid on the same day due to potential skin irritation and dryness. However, if you do not have sensitive skin or do not experience any skin irritation using salicylic acid and benzoyl peroxide on alternate days, you may try using salicylic acid in the morning and a benzoyl peroxide product at night because benzoyl peroxide may stain your clothes.

Which is more effective, salicylic acid or benzoyl peroxide?

It depends on the type of acne lesions you have. Both benzoyl peroxide and salicylic acid are comedolytic, meaning they dissolve whiteheads and blackheads, with salicylic acid being better.

Furthermore, benzoyl peroxide is an antibacterial and more effective against inflammatory red papules and pustules.

However, as the mechanisms behind acne depend on multiple factors, the most efficient treatment tends to be a combination therapy that targets different mechanisms. Studies show that combining benzoyl peroxide with salicylic acid is more efficient at clearing acne than benzoyl peroxide alone^[26].  

Who should not use benzoyl peroxide and salicylic acid?

Dr. Miller says that people who are allergic to aspirin or other NSAIDs should avoid using salicylic acid or if your skin has previously reacted to products containing these ingredients, you should be cautious.

Dr. Miller also recommends trying a new product in a small skin area at first to see how your skin reacts. Some patients may develop contact dermatitis from benzoyl peroxide or salicylic acid with intense redness (erythema), irritation and itch, and if this is the case the product should be discontinued.

Patients using concomitant topical tretinoin against acne should not apply topical benzoyl peroxide at the same time as it may neutralize the effect of tretinoin^[27].

If you are already using a topical treatment prescribed by your dermatologist or suffer from a concomitant skin condition like eczema, rosacea, or psoriasis, always ask your dermatologist before starting a new product.

Pregnant women should not use high-concentration salicylic acid chemical peels as it is considered teratogenic.

How to get a prescription for benzoyl peroxide and salicylic acid?

Benzoyl peroxide and salicylic acid are two of the most known skincare products, they are sold over the counter in the United States or with a prescription depending on the product’s concentration. If you have tried OTC acne medications and they don’t produce the expected results, click on the “start a consultation” button below to get prescription-grade treatment for your acne.

Lee el artículo en Español ¿Qué es el peróxido de benzoilo y cómo se compara con el ácido salicílico?

Article References:

1 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
2 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
3 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
4 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
5 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
6 https: //pubmed. Ncbi. Nlm. Nih. Gov/30725905/
7 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
8 https: //pubmed. Ncbi. Nlm. Nih. Gov/23839205/
9 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
10 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
11 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
12 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
13 https: //www. Ncbi. Nlm. Nih. Gov/books/nbk537220/
14 https: //www. Fda. Gov/cosmetics/cosmetic-ingredients/beta-hydroxy-acids
15 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
16 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
17 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
18 https: //pubmed. Ncbi. Nlm. Nih. Gov/30972839/
19 https: //pubmed. Ncbi. Nlm. Nih. Gov/30972839/
20 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
21 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc2791365/
22 https: //pubmed. Ncbi. Nlm. Nih. Gov/23657872/
23 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/#! Po=31.2500
24 https: //www. Ncbi. Nlm. Nih. Gov/pmc/articles/pmc4554394/
25 https: //pubmed. Ncbi. Nlm. Nih. Gov/20488582/
26 https: //pubmed. Ncbi. Nlm. Nih. Gov/26897386/