Skincare Problem-Solving: BHAs for Acne

Nothing made my acne go away.  I tried everything available over-the-counter.  Dermatologists prescribed me topical and oral antibiotics and Retin-A.  I even went on Accutane, the “scorched earth option” for acne treatment, which involved monthly blood draws and the 2/3 likelihood of a permanent solution.  None of it worked for more than a couple of weeks, which makes sense in retrospect– I turned out to have a hormonal imbalance that makes it super difficult to get rid of acne.

I tell you that to give you hope, because the ingredients I thought didn’t work for me actually did.  I just had to learn what made them effective!  Here’s how to fix common problems you might be experiencing with my personal favorite ingredient for dealing with acne– salicylic acid (also known as a beta hydroxy acid, or BHA).  This topic may be familiar for anyone who’s been reading the blog since April of last year.

Help, Lishan, my salicylic acid face wash does not work.

Oof, I’ve been there!  BHAs don’t work in rinse-off products.  Salicylic acid needs to penetrate deep into your pores to work, and a face wash doesn’t stay on your face long enough.  Buy a separate salicylic acid leave-on product: my personal favorite is Paula’s Choice’s BHA Gel Exfoliant (effective, soothing, and I can apply it with my fingers instead of a cotton ball!), but her most popular one is the Skin-Protecting 2% BHA Liquid.

Now I bought a leave-on BHA product but it doesn’t seem to do anything.

This is probably because the company making your skincare doesn’t understand how salicylic acid needs to be formulated to work.  Specifically, BHAs are most effective at a pH between 3 and 4.

How do you find out if your leave-on BHA product falls into that range?  Short of getting pool test strips, a good way to find out is to check the Beautypedia Best BHA reviews, see what’s well-rated, see if most people like them, and give them a try.

Help, Lishan, salicylic acid dries out my face too much.

Salicylic acid itself is not usually drying!  If you’re experiencing dryness, it likely means one of two things:

  • Your skincare products are full of bad ingredients.  For some reason, people like to pack anti-acne products full of witch hazel, peppermint, lavender, and isopropyl alcohol / denatured alcohol (not to be confused with the good-for-skin (link)fatty alcohols).  All of those, along with most fragrance ingredients, are irritating to the skin.  Avoid those ingredients in your skincare.
  • Your skincare products are formulated with good ingredients that can be drying.  Most of the other common active ingredients used in OTC anti-acne treatments can be drying, especially benzoyl peroxide or retinol.  If you use benzoyl peroxide or retinol products, try using them less frequently and/or switching to a product that contains less of them.

Other things that could be the trouble:

  • You’re washing your face too much.  Generally, don’t wash your face more than twice a day, and use a gentle cleanser, not something full of grainy, scratchy physical exfoliants.
  • This level of BHA is too strong for your skin.  If you’re using a 2% salicylic acid product, try switching to a 1% product.  If you’re using salicylic acid twice a day, try switching to once.


Help, Lishan, my salicylic acid products break me out.

Hi!  This is common, but might not actually mean salicylic acid doesn’t work for you!  A lot of people who switch to an effective salicylic acid product experience a skin purging that temporarily worsens acne.  If you’re not experiencing any obvious irritation, and you’re breaking out extra after starting on a salicylic acid regimen, keep using it at least once a day for a month before deciding that it doesn’t work for you.

Another possibility here is that you’ve found one of the rare salicylic acid products that’s otherwise well-formulated but is too moisturizing for your skin, but honestly, unless you’re trying Paula’s Choice’s lotion exfoliant I think that’s unlikely.  It is possible you’re using a moisturizer too that’s too rich for your skin– some people with acne go entirely without a moisturizer or use a toner instead because all of the moisturizers they can find are too rich or too silicone-y (silicone is not a bad ingredient but some people feel it blocks their pores.)

Help, Lishan, I *am* experiencing obvious irritation, there are no previously listed bad ingredients in here, I’m not using any other potentially irritating products, and I tried adjusting the dose!

Do your products contain niacinamide?  Niacinamide can also cause people with sensitive skin to have a red, flushed face.  If your products contain that, try switching to a product that doesn’t.

Are you allergic to ibuprofen?  Aspirin?  Other NSAIDs?  People who are allergic to one of those are also often allergic to salicylic acid.  (Not always!  I happen to have one allergy but not the other.  I suggest testing a BHA on a tiny patch of your not-face skin to make sure you don’t have an allergic reaction before trying it on your face.)

If neither of these are your problem, or if you’re experiencing obvious irritation that the rest of the problem-solving here doesn’t address, discontinue the product and consult a dermatologist.  I am a nerd, but I do not have any kind of certification!

The Takeaway:

  • Formulation matters.  Anti-acne products have to be formulated in a very specific way to be effective, and most over-the-counter acne treatments do not take that into consideration.  Also, most of them include bonus irritants.
  • How you use skincare matters.  Some anti-acne ingredients are hard for skin to adjust to and require you to build up a tolerance.  Others have to be used every day and might make you break out more at first.  Knowing what to expect from each active ingredient can help you get a good routine going, and routine is super important for clearing up your skin.
  • Your individual skin matters.  Anti-acne ingredients that are super good for some people’s skin might make your face red and inflamed.  It’s important to try things and figure out what works for your skin (within reason).  I recommend Paula’s Choice partly because they’re one of the few actually good skincare lines that offers sample or trial sizes of virtually all of their products.

I hope it helps!


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