How to Use Salicylic Acid to Treat Psoriasis

While you might be most familiar with salicylic acid for its role as an exfoliant, helping to unblock pores, brighten skin, and clear acne, it can also be used to treat psoriasis. Just look at the labels of products formulated for psoriasis; you’ll often find this ingredient, which is a type of beta hydroxy acid, listed there.

With so many new innovations for treating psoriasis emerging these days, it’s natural to wonder: Does salicylic acid really work on psoriasis? And if so, what type of product should you look? After all, from prescription-level psoriasis creams with salicylic acid to over-the-counter shampoos with salicylic acid for scalp psoriasis, the options are growing. We asked top dermatologists how to use the ingredient to your advantage in your daily psoriasis routine to keep your skin clear and comfortable.

“Salicylic acid is a keratolytic agent, meaning it can break down skin cells,” says Geeta Yadav, M.D., a board-certified dermatologist based in Toronto, Ontario. “It also has anti-inflammatory effects.”

That makes it especially helpful for treating plaque psoriasis, the most common type of psoriasis, which is characterized by raised plaques on skin that result from the abnormally fast production of skin cells triggered by an overactive immune system. Because this can cause inflammation, the plaques might be red and itchy, too.

With psoriasis, a chronic inflammatory condition, treating the plaques with salicylic acid can both improve their appearance and reduce their size, Dr. Yadav says. Research published in the journal Dermatology and Therapy found that salicylic acid alone can be beneficial for treating psoriasis plaques in some people, although it can also be paired with other medications, too, for more severe psoriasis cases.

The primary benefit of using salicylic acid for psoriasis is in its keratolytic effect (a.k.a. the exfoliation and removal of skin cells), says Jerry Bagel, M.D., a board-certified dermatologist in East Windsor, NJ. However, he says, while salicylic acid targets the physical plaques themselves, it won’t target the root cause of the plaques. You’ll need to get a prescription for a systemic medication to get the disease under control from an autoimmune standpoint. Still, “removing scales does improve the ability of topical steroids and UV light to penetrate the [top layers of] skin,” he adds. So, it can make for a strategic supplement to other psoriasis treatments—systemic and topical.

The maximum concentration of salicylic acid allowed in over-the-counter products is 2%. While that can be helpful, “concentrations of 3% or greater are best for treating psoriasis,” says Dr. Yadav. “These options may require a prescription from a dermatologist, depending on the formulation.” The advantage here is that if you’re seeing your doctor for a prescription for a stronger psoriasis salicylic acid cream, they may recommend other pairings that could work well for your individual case.

In fact, the authors of a literature review published in Indian Dermatology Online Journal found that ointments containing salicylic acid significantly boosted the effectiveness of topical corticosteroids by exfoliating psoriasis patches for better penetration. So, if the over-the-counter salicylic acid cream isn’t quite doing the job, see a dermatologist for a stronger concentration.

When you’re shopping for an over-the-counter formula, start by looking for psoriasis products with salicylic acid in addition to moisturizing ingredients. “Salicylic acid can be dehydrating—and those with psoriasis already have chronically dry skin,” says Dr. Yadav. She recommends the CeraVe Psoriasis Therapy Cleanser, as it “features ceramides to help seal moisture into the skin, as well as salicylic acid,” she says.

Also, consider the areas of your body where you’re most impacted by the psoriasis. For instance, you should look for a keratolytic hair product, like a shampoo with salicylic acid, for scalp psoriasis. Again, combining ingredients can be helpful here; for example, using “Neutrogena T/Sal Therapeutic Shampoo in the morning can be an adjunct to topical steroids at night to improve scalp psoriasis,” says Dr. Bagel.

However, “if your skin is not responding to an over-the-counter treatment for psoriasis, you should seek help from your dermatologist,” Dr. Yadav says. (And, she says, your condition should be monitored by your doctor no matter what.) When it comes to prescriptions, there are a variety of options. Dr. Bagel recommends a pharmacy-compounded formulation of 5% salicylic acid, steroids, and 10% coal tar, alongside UV light to address stubborn plaques.

Salicylic acid is generally safe and gentle on most skin types, but as with any medicated topical, it can come with a few possible side effects, per the Mayo Clinic, including:

• Dryness

• Increased sensitivity to sunlight

• Irritation

• Skin peeling

Since these side effects can be frustrating for those with already sensitive skin, “it’s best to perform a patch test using your product of choice on a small area before committing to widespread use to ensure you don’t react negatively to the formula,” says Dr. Yadav.

While extremely rare, at certain concentrations salicylic acid could lead to serious side effects, including:

• Convulsions

• Hallucinations

• Salicylism, an adverse event resulting in dizziness and blurred vision

• Vomiting

Again, these side effects are rare; for instance, you would need to apply a “high-enough concentration over a large-enough body surface area,” says Steven Feldman, M.D., a board-certified dermatologist and professor at Wake Forest School of Medicine in Winston-Salem, NC. If you’re getting a prescription-strength compound from your doctor, they’ll be able to monitor you and help prevent negative reactions.

In addition to salicylic acid, other topical treatments can help with psoriasis. “Just using a standard moisturizer could [hydrate] the psoriasis and help break up thick scales,” says Dr. Feldman. Research has found that emollient formulas, like Vaseline, can improve skin barrier function. And, in the same vein as salicylic acid, certain cleansers and exfoliants can also help soften and smooth scaly skin.

For certain areas of the body, like the face and genitals, mild steroids may also be helpful. Dr. Feldman points to a 1% hydrocortisone cream, which is typically the maximum amount allowed over the counter. (It won’t be potent enough for areas elsewhere, though.) For those, Dr. Feldman offers another trick for getting a medium-strength topical steroid treatment over the counter. “Over the counter topical Flonase (fluticasone) or topical Nasicor (triamcinolone), come in nasal sprays that you can spritz on psoriasis patches located on your elbows and knees,” he says. It won’t take the place of prescription medication and a board-certified dermatologist, who should still be overseeing your care, but may offer some major itch relief. Dr. Feldman is on to something—a study published in the Journal of the American Academy of Dermatology found that people with psoriasis who applied an ointment containing fluticasone saw 50% improvement of their skin after two weeks.

Coal tar, which can be found as an ointment at the drugstore, is another effective ingredient for psoriasis. “One of the newly approved topical treatments for psoriasis, Vtama (tapinarof), works by activating the aryl hydrocarbon receptors, and scientists found that coal tar does the same thing,” says Dr. Feldman. Aryl hydrocarbon receptors are proteins found in cells that play a role in skin barrier function, inflammation and immune response, and detoxification.

Salicylic acid’s claim to fame when it comes to helping treat psoriasis is its ability to promote the shedding of dead skin cells and reduce inflammation, which in turn helps manage symptoms associated with psoriasis. It’s important to remember that everyone’s skin needs are different, though, and what works for one person might not work for another. The best thing you can do before going all in on incorporating salicylic acid into your psoriasis treatment plan is to talk with a dermatologist to determine the best product and ingredient strength for you.