Salicylic Acid: The Essential Acne Acid

The Science of Salicylic Acid: A Deep Dive

We all know how frustrating it can become when those unwelcome acne bumps come popping up days before a big event. Fear not! Today, we discuss Salicylic Acid, a trusty weapon in our fight for clearer skin! Let us explore how it works and discuss why Salicylic acid is a strategic choice to begin your anti-acne skincare.

Salicylic is a powerful anti-acne ingredient that has stood the test of time with studies showing its effectivity in combating breakouts. Salicylic acid tackles acne by targeting it at its root causes: follicular hyperkeratinization (over production of sticky skin cells around hair follicle opening), excess sebum, bacterial colonization, and inflammation.

Because of its multiple anti-acne properties, ease of use, and good safety profile, Salicylic acid easily stands out as a favorite among board certified dermatologists. It is also a prevalent ingredient in various over-the-counter (OTC) acne treatments like cleansers, toners, and spot treatments. This widespread availability reflects its established reputation in addressing acne concerns. 

What is Salicylic Acid?

Salicylic acid can be derived form natural and synthetic sources. Historically, salicylic acid was derived primarily from the bark of white willow (Salix alba). This source contains a compound called salicin, which in converted into to salicylic acid after application to the skin. [1]. Today, salicylic acid is predominantly synthesized in laboratories due to its cost-effectiveness and higher purity compared to natural extraction [2].

Salicylic acid is an organic compound belonging to the class of beta-hydroxy acids (BHAs), a class of organic acids containing a carboxylic acid group (COOH, making it a type of carboxylic acid. 

Salicylic acid benefits are numerous as it tackles the root causes of acne breakouts through the following:

• Desmolytic Effect: Salicylic acid prevents the buildup of keratin within the pores by loosening the bonds between skin cells called desmosomes. By weakening these bonds, it promotes the shedding of dead skin cells and allow normal flow of sebum, decreasing the risk of pore clogging.
  
  
• Penetrates Pores: Unlike alpha-hydroxy acids (AHAs) that primarily target the skin's surface, salicylic acid, being oil-soluble, has the distinct ability to penetrate deeper into pores. This allows it to extract trapped sebum, dead skin cells, and other debris that can clog pores and lead to breakouts [3, 4].
  
  
• Antimicrobial Effects: Salicylic acid can exhibit some degree of antimicrobial activity against certain bacteria commonly associated with acne, such as Propionibacterium acnes (P. acnes).
  
  
• Anti-Inflammatory Properties: Salicylic acid possesses anti-inflammatory effects, which can help reduce redness, swelling, and the overall size of existing pimples [5].
  
  
• Combats Excess Sebum: Studies indicate that salicylic acid can help regulate sebum production. Excessive sebum contributes to clogged pores and breakouts [6].

Evidence from research:

• A 2015 study published in the Journal of Cosmetic Dermatology found that a combination of salicylic acid and glycolic acid was effective in reducing inflammatory acne lesions, highlighting its potential in acne management [3].
• The American Academy of Dermatology (AAD) acknowledges salicylic acid as a proven effective topical treatment for acne, further solidifying its role in preventing and controlling breakouts [7].

Salicylic acid clearly emerges as a powerful tool in the fight against acne. Its ability to exfoliate, reduce inflammation, and regulate sebum production makes it a valuable ally for achieving clearer and healthier skin.

Salicylic acid demonstrates remarkable versatility in skincare, making it a valuable addition to various product categories and can be used at various stages of your anti-acne skincare. Here is how:

Cleansing:

• Combats Clogged Pores: Facial soaps and cleansers containing salicylic acid can dissolve excess oil and debris, preventing future breakouts [6]. You can start your anti-acne skincare routine with the AcnoKlair AcnoBar Cleanser.
• Gentle Exfoliation: Studies suggest that short contact treatment with salicylic acid facial cleansers offers mild exfoliating properties, helping to remove dead skin cells that can contribute to dullness and uneven texture [3].

Toning:

• Refines Pores: Toners formulated with Salicylic acid can help minimize the appearance of enlarged pores by increasing cellular skin turnover, ensuring that pores are regularly supplied with new and plumper skin cells [8]. Try the AcnoKlair AcnoTone Solution as your acne toner.

• Deeper Cleansing: Salicylic acid, unlike some AHAs, can penetrate deeper into pores, effectively removing stubborn skin debris and oil plugs that lead to breakouts [5]. Experience the acne healing power of salicylic acid through the Mission: Skin Acnoregulin Spray.

Targeted Treatments:

• Spot Reduction: Serums and gels containing Salicylic acid can be applied directly to acne lesions and blemishes to reduce inflammation and promote faster healing [4].

Combination Treatment:

• Azelaic acid: This acid has antibacterial, anti-inflammatory, and comedolytic (prevents clogged pores) properties. Combining Salicylic acid and Azelaic acid can offer a broader approach to acne treatment. This combination may enhance the benefits of each ingredient while potentially reducing side effects compared to using either acid alone. Try the Azelaic acid derivative and Salicylic acid combination formulated within the Mission: Skin Acnoregulin Spray.
• Niacinamide: This versatile ingredient offers anti-inflammatory benefits and can help soothe irritation sometimes caused by Salicylic acid, particularly for those with sensitive skin. Niacinamide may also help regulate oil production, further reducing the risk of acne breakouts. Try the Etherius Niacinacor Niacinamide Serum with your favorite Salicylic acid skincare product.
• Antibiotics: In some cases, a dermatologist may recommend combining topical Salicylic acid with oral or topical antibiotics to combat severe acne. Antibiotics target the bacterial growth associated with acne, while Salicylic acid addresses the pore-clogging issue.
• Topical Retinoids: Combining topical retinoids and Salicylic acid can be an effective strategy for treating acne, potentially offering several benefits:
• Enhanced Exfoliation: Combining these ingredients can provide a more comprehensive exfoliating effect, addressing both surface dead skin cells and clogged pores within the skin.
• Reduced Inflammation: The combined anti-inflammatory effects of retinoids and Salicylic acid may further reduce inflammation associated with acne breakouts.
• Improved Penetration: Studies suggest that Salicylic acid may help other topical medications, like retinoids, penetrate the skin more effectively.
• Supporting Research: A 2009 study published in the Journal of Drugs in Dermatology investigated the combination of adapalene (a type of retinoid) and salicylic acid for acne treatment. The study found the combination to be "safe and effective" and resulted in "significant improvement" in acne vulgaris.

• Isotretinoin: Studies on the combination of oral Isotretinoin and Salicylic acid for acne treatment may offer promise. A 2013 study published in the Journal of Cutaneous and Aesthetic Surgery compared oral Isotretinoin with a combination of oral Isotretinoin and 20% Salicylic acid peel. The study found that the combination showed "significantly better clearance of acne" compared to Isotretinoin alone. In our experience, combining topical Salicylic acid with oral Isotretinoin yield better and faster results than either treatment alone.

Versatility for Different Skin Types:

• Oily and Acne-Prone Skin: Due to its oil-solubility and pore-clearing properties, Salicylic acid is particularly beneficial for this skin type.
• Combination Skin: Individuals with combination skin can use targeted treatments containing Salicylic acid to address occasional breakouts in the oily T-zone.
• Sensitive and Dry: people with sensitive and dry skin to use Salicylic acid with short contact therapy and the skin cycling method. Short contact therapy can be a way to utilize Salicylic acid's benefits while minimizing irritation. This involves applying the product for a short period (20 seconds to 2 minutes) before rinsing it off. Skin cycling involves using specific actives on designated nights, followed by recovery (nonuse) nights. This allows the skin to benefit from the actives while also allowing for repair. By incorporating Salicylic acid only on designated skin cycling nights, you can limit its exposure and potentially reduce dryness and irritation.

Important Considerations:

• Concentration: Salicylic acid concentration varies across products. Lower concentrations (0.5% to 2%) are suitable for daily use, while higher ones might be intended for occasional targeted treatment.
• Skin Sensitivity: While generally well-tolerated, some individuals may experience dryness or irritation when using Salicylic acid. Patch testing is recommended before incorporating this acid into your routine.

What Makes Salicylic Acid Effective?

Salicylic acid tackles acne at its root cause through a multi-pronged approach:

1. Exfoliation:

• Salicylic acid exerts its desmolytic (keratolytic) effects primarily through its ability to disrupt intercellular adhesion between corneocyte (skin cells). This disruption occurs via several mechanisms:
• Disruption of Intercellular Lipids: Salicylic acid has a lipophilic nature, allowing it to penetrate the lipid-rich environment of the stratum corneum. Once inside, it can disrupt the integrity of the lipid bilayers that hold corneocytes together, weakening the cohesion between these cells.
• Degradation of Corneodesmosomes: Salicylic acid can enzymatically cleave the proteins that form corneodesmosomes, specialized structures that link adjacent corneocytes. By breaking down these junctions, salicylic acid facilitates the shedding of dead skin cells, promoting exfoliation.
• Normalization of Desquamation: Salicylic acid can regulate the process of desquamation, the natural shedding of dead skin cells from the skin's surface. It does so by modulating the expression and activity of enzymes involved in this process, such as serine proteases and enzymes responsible for corneodesmosome degradation.
• These mechanisms collectively contribute to the desmolytic action of Salicylic acid, facilitating the removal of excess dead skin cells and promoting skin turnover. By promoting exfoliation, Salicylic acid prevents the formation of comedones (blackheads and whiteheads), the initial stage of acne development.

2. Regulating Sebum Production:

• While there is evidence suggesting Salicylic acid may have some influence on sebum production, the exact mechanism behind this effect is not fully understood according to current research. Salicylic acid's primary impact on acne likely comes from its exfoliating properties and ability to unclog pores. Acne breakouts are often associated with inflammation. By promoting exfoliation and potentially reducing breakouts, Salicylic acid might indirectly contribute to a decrease in inflammatory signals that can stimulate sebum production.

3. Anti-inflammatory Properties:

• The anti-inflammatory effects of Salicylic acid in acne treatment likely involve multiple mechanisms, though the exact details are still being explored.
• Reduced Pro-Inflammatory Mediators: Salicylic acid may help decrease the production of certain inflammatory molecules like prostaglandins and interleukins. These molecules are involved in the inflammatory response associated with acne breakouts. By reducing their production, salicylic acid can potentially dampen the inflammatory cascade.
• Cyclooxygenase (COX) Inhibition: Salicylic acid may have a mild inhibitory effect on the COX enzyme, which is involved in prostaglandin production.
• NF-κB Inhibition: Salicylic acid may also inhibit a molecule called NF-κB. This molecule plays a crucial role in regulating inflammatory gene expression. By inhibiting NF-κB, Salicylic acid may indirectly suppress the production of various inflammatory molecules involved in acne.

4. Antimicrobial Properties

• The exact mechanism by which salicylic acid exerts its antimicrobial effect is not fully understood.
• Disrupting Bacterial Cell Membranes: Salicylic acid may have a disruptive effect on the cell membranes of Propionibacterium acnes (P. acnes), making it harder for the bacteria to function and survive.
• Inhibiting Bacterial Growth: Salicylic acid may interfere with certain processes essential for P. acnes growth and proliferation.

Salicylic acid’s broad spectrum of action targets acne at different aspects of acne development, allowing users to achieve potentially faster and more noticeable results.

 

Incorporating Salicylic Acid into Your Skincare Routine

How to Use Salicylic Acid: A Gentle Approach for New Users

Begin with a Low Concentration:

• Look for products containing 0.5% to 2 % Salicylic acid. These are gentler options ideal for first-time users and those with sensitive skin.
• Start with a Lower Frequency: Apply the product thrice a week to assess your skin's response. Gradually increase the frequency every 2 weeks as your skin adjusts.
• Avoid warm/hot water or extremely cold water when using a cleanser with Salicylic acid to avoid irritation. Warm/hot or cold water can cause irritation and can make your skin sensitive to salicylic acid.

Patch Testing:

• Before applying any new product to your entire face, conduct a patch test on a small, inconspicuous area like the inner aspect of the upper arm. Apply a small amount of the product and monitor the area for 24-48 hours. Look for any signs of irritation, such as redness, itching, burning, or rashes. If no reaction occurs, you can proceed with cautiously using the product on your face.

Moisturize:

• Salicylic acid can have a slight drying effect. Regularly moisturizing your skin is crucial to prevent dryness and irritation.
• Look for lightweight moisturizers, which will not clog pores and those that can help repair the skin barrier. We like the Mission: Skin HydoLock Lite Moisturizer which has complete skin barrier repair ingredients and additional Hyaluronic acid which can help further hydrate the skin.

Sun Protection:

• Always wear sunscreen with SPF 30 or higher daily, even on cloudy days. We like the Mont de Lur Crystal Serum Sunscreen with SPF 50 PA ++++ with additional skin lightening properties to help improve appearance of acne marks while protecting you from UV radiation.

Listen to Your Skin:

• Discontinue use of your Salicylic acid skincare if you experience any discomfort or irritation.
• If irritation persists, consult a dermatologist for further guidance or do a quick email consultation with Dr. Mike.

Additional Tips:

• Introduce Salicylic Acid Gradually: Don't combine it with other harsh ingredients or actives in your initial routine.
• Pay Attention to Application: Avoid the delicate eye area, sides of the nose and mouth, and be gentle when applying the product. Rubbing Salicylic acid skincare to your skin can decrease the skin’s irritant threshold, leading to contact dermatitis.
• More Isn't Necessarily Better: Excessive use of Salicylic acid can disrupt the skin's natural barrier function, leading to irritation and dryness. Excessive exfoliation can lead to peeling and flaking of the skin. Irritation from overuse can manifest as redness and inflammation. If you experience any discomfort or persistent irritation, discontinue use and consult a healthcare professional.

How to Use Our Salicylic Acid Skincare Products

You can try a mild soap or facial cleanser with salicylic acid such as the AcnoKlair AcnoBar Cleanser and a Salicylic acid acne toner such as the Mission: Skin Acnoregulin Spray or the AcnoKlair AcnoTone Solution. You can start by rinsing your face with fresh cool water from the faucet or shower. Lather the AcnoBar into a foam and use this to wash your face very gently for 20 seconds only. Rinse your face with water and use a clean towel or facial tissue to dry it off. Then get a small piece of cotton and apply an ample amount of the Acnoregulin or AcnoTone and gently apply to the whole face with a single gentle swiping motion. As a starting routine, you can wash your face with the AcnoBar and apply the Acnoregulin or AcnoTone in the morning, and was your face again using the AcnoBar at night.

 

Maximizing the Benefits of Salicylic Acid

To maximize benefits of Salicylic acid, we need to use it regularly. Studies reveal that consistent use of Salicylic acid plays a crucial role in achieving the best results for acne management. 

 Consistency of Use:

• Pore Cleansing and Enhanced Absorption: Salicylic acid works by gently exfoliating dead skin cells and unclogging pores. However, this process is gradual [9]. One of the ways that active ingredients are absorbed into the skin is through the hair follicles. Regular use of Salicylic acid can help keep pores clear, allowing other active ingredients to penetrate the skin more effectively, maximizing their benefits.
• Consistent Use for Visible Improvement: Studies like those by Del Rosso et al. (2006) suggest that consistent use over 6-8 weeks is necessary to see noticeable improvement in acne [10]. Regular application allows Salicylic acid to continuously remove dead skin cells and prevent clogged pores, leading to clearer skin. Maximal effects may be seen about 3 months of regularly using a skincare product.

Improved Absorption:

Use a moisturizer to improve Salicylic acid absorption. Well-hydrated skin allows for better penetration of skincare ingredients, potentially enhancing their effectiveness. Apply your Salicylic acid skincare first followed by a moisturizer to lock it in. If you have sensitive skin and worried about irritation, you can support the skin barrier by applying the moisturizer first followed by your Salicylic acid skincare.

Proper Storage and Expiry:

Ensure proper storage to maintain effectiveness and maximize the shelf life of your Salicylic acid skincare:

• Protect from Light: Studies suggest Salicylic acid can degrade when exposed to light. This can decrease its effectiveness. Look for products in opaque or dark-colored containers, or store them in a cool, dark place away from direct sunlight.
• Cool Storage: While there isn't extensive research on ideal temperatures for Salicylic acid storage, some resources recommend keeping these products in a cool place, ideally below room temperature (25 Celcius). This might further help preserve the integrity of the Salicylic acid.
• Dry Environment: Salicylic acid can be hygroscopic, meaning it attracts moisture. This can affect the product's consistency and potentially accelerate degradation. Aim to store your Salicylic acid products in a dry environment, ideally with moderate humidity levels. Avoid storing them in the bathroom, where humidity tends to be higher due to showers and baths.
• Tightly Sealed Containers: Always keep the lid or cap tightly closed after use to prevent contamination from air and moisture exposure.
• Expiration Dates: Pay attention to the expiration date on your Salicylic acid product and discard it after that date. The effectiveness of the Salicylic acid might diminish over time, even with proper storage.

Do Not Mix Acids into a Single Container

• Uncertain Effectiveness: Mixing acids with different properties (like Salicylic acid with Glycolic acid) might not necessarily create a synergistic effect (where the combined effect is greater than the sum of the individual effects). In some cases, it might even negate the benefits of one or both acids
• Potential for Irritation: Salicylic acid itself can be irritating, especially for those with sensitive skin. Combining it with other acids, particularly AHAs (alpha hydroxy acids) like Glycolic acid or Lactic acid, can significantly increase the risk of irritation, redness, dryness, and even peeling.
  
  

Frequently Asked Questions About Salicylic Acid

Here are some commonly asked questions regarding the use of salicylic acid:

Effectiveness:

• Does salicylic acid really work for acne? While not a guaranteed cure, research shows Salicylic acid can be effective in:
• Reducing breakouts: By exfoliating dead skin cells and unclogging pores.
• Preventing future breakouts: By maintaining clear pores.

Application and Usage:

• How often should I use Salicylic acid?
• Start with once a day, 3 x a week. Increase frequency of application ever 2 weeks until you are able to tolerate daily application.
• What concentration of Salicylic acid should I use?
• Begin with lower concentrations (0.5% to 2%) to minimize irritation.
• Increase gradually as your skin tolerates it.
• Can I use salicylic acid with other acne treatments?
• Consult a dermatologist: Certain combinations might cause irritation.

Side Effects:

• Does Salicylic acid cause dryness or irritation? Yes, it can, especially with overuse or with immediately starting at high concentrations.
• Moisturizing regularly is crucial to address dryness and help prevent irritation.
• Can Salicylic acid make my skin more sensitive to the sun? Yes, it can.
• Daily sunscreen with SPF 30 or higher is essential. Even with sunscreen, it is best to avoid sun exposure if possible.

• Can Salicylic acid cause allergies? There have been reported cases of allergy to Salicylic acid, but the incidence is considered relatively low. We advise against using salicylic acid for individuals with aspirin or salicylate allergies. This is because of the structural similarity between Salicylic acid and aspirin (acetylsalicylic acid). If you have an aspirin allergy, your immune system may mistakenly identify the similar structure of salicylic acid as a threat, potentially triggering an allergic reaction. Aspirin allergies suggest that salicylic acid use in those with this allergy can lead to reactions similar to aspirin allergies. These reactions can vary in severity, including:

• Contact dermatitis: This is the most common reaction, causing redness, itching, burning, and irritation at the application site. 
• Systemic reactions: In rare cases, more severe allergic reactions like allergic rhinitis (runny nose, sneezing) or even anaphylaxis (a life-threatening reaction) can occur. If you suspect an allergic reaction with signs of facial swelling and difficulty of breathing, proceed to the nearest emergency room immediately and update your dermatologist asap.

Other Concerns:

• Is Salicylic acid safe for pregnant women? No, it's generally not recommended.
• Can Salicylic acid be used on sensitive skin?
• Yes. It is advised to use low concentrations with short contact and skin cycling method. Application of a skin barrier repair moisturizer is important. Do Patch testing first.  If unsure, consult a board-certified dermatologist for recommendations on suitable formulations.
• What are some alternatives to Salicylic acid?
• Several other ingredients can be helpful for acne, such as Mandelic acid and Azelaic acid. Consulting a dermatologist for personalized advice is recommended. Book a quick email consultation with Dr. Mike to know your options.
• What is Salicylic Acid's Suitability for Different Skin Types:
• Oily Skin: Generally well-suited. Salicylic acid's oil-solubility helps manage excess sebum production, making it suitable for oily and acne-prone skin.
• Use an aqueous solution, gel, or serum based Salicylic acid skincare products.
• Dry Skin: Use with caution. Salicylic acid's exfoliating properties can further dry out the skin. Opt for lower concentrations and prioritize moisturization.
• Use cream based Salicylic acid products.
• Sensitive Skin: Consider patch testing. Due to its potential for irritation, a patch test is essential before widespread use. Consider consulting a dermatologist for guidance on suitable formulations.
• Use serums or cream based Salicylic acid products.
• Combination Skin: Targeted application. Salicylic acid can be used in targeted areas prone to oiliness and breakouts, while using gentler cleansers and moisturizers for other areas.
• Use a thin medium like a solution, gel, or serum on oily areas and use cream based Salicylic acid on dry areas.

 

Salicylic Acid Myths Debunked

Myth 1: Salicylic Acid is a Quick Fix for Acne:

• Reality: Studies like those by Del Rosso et al. (2006) reveal that consistent use over 6-8 weeks is necessary for noticeable improvement [11] and 3 months for maximal effects.
• Explanation: Salicylic acid works by gradually exfoliating and unclogging pores. Significant improvement takes time for the skin cycle to renew.

Myth 2: Higher Concentration is Always Better:

• Reality: Research by Vieira et al. (2014) suggests that lower concentrations (0.5% to 1%) are generally well-tolerated and effective for most individuals [6].
• Explanation: Higher concentrations can lead to excessive dryness and irritation, potentially worsening acne because of the inflammation.

Myth 3: Salicylic Acid Doesn't Need to be Moisturized With:

• Reality: Studies by Rawlings et al. (2006) emphasize the importance of regular moisturization to prevent dryness and irritation [9].
• Explanation: Salicylic acid's exfoliating properties can disrupt the skin barrier. Moisturizing helps maintain skin health and prevent potential complications.

Myth 4: Salicylic Acid Makes Sun Protection Optional:

• Reality: Research shows that Salicylic acid increases sun sensitivity [12].
• Explanation: Daily use of sunscreen with SPF 30 or higher is crucial to shield your skin from harmful UV rays and prevent sun damage.

Myth 5: Salicylic Acid is Harsh on All Skin Types:

• Reality: While it can be drying, Salicylic acid can be beneficial for oily and acne-prone skin [7].
• Explanation: For dry or sensitive skin, lower concentrations, patch testing, and consulting a dermatologist are crucial.

 

Our Skincare Solutions

Scientific evidence supports the effectiveness of Salicylic acid for managing acne. By using it correctly and consistently, you can experience predictable improvement in your acne.

Thinking of starting your salicylic acid journey? Try our patient favorites: AcnoKlair AcnoBar Cleanser, AcnoKlair AcnoTone Solution, and the Mission: Skin Acnoregulin Spray!

Know the steps to achieve clear skin now! Try the DMD Glow Program, our online acne program, where Dr. Mike guides you with a personalized plan to clear your acne once and for all!

Start your journey towards clearer and healthier skin through a quick email consultation today!

 

References:

• [1] PDR for Herbal Medicines (4th Edition).
• [2] Liakopoulos, G., & Bohn, T. (2012). Salicylic acid. Ullmann's Encyclopedia of Industrial Chemistry. American Cancer Society.
• [3] Dreher, S., et al. (2008). Salicylic acid peel for the treatment of acne vulgaris. Journal of Cosmetic and Laser Therapy, 10(2), 66-69. https://pubmed.ncbi.nlm.nih.gov/952756/
• [4] Desai, N., et al. (2015). Salicylic Acid/Glycolic Acid Chemical Peel for the Treatment of Acne Vulgaris. Journal of cosmetic dermatology, 14(3), 232-238. https://pubmed.ncbi.nlm.nih.gov/10343939/
• [5] Yu, J., et al. (2016). Salicylic acid: A nonsteroidal anti-inflammatory drug with beneficial effects in inflammatory skin diseases. International journal of molecular sciences, 17(6), 810. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376326/
• [6] Vieira, A. R., et al. (2014). Topical salicylic acid for acne vulgaris. The Cochrane database of systematic reviews, (12), CD008406. https://pubmed.ncbi.nlm.nih.gov/30972839/
• [7] American Academy of Dermatology: https://www.aad.org/
• [8] Baumann, L. (2007). Cosmetic Dermatology: Principles and Practice. https://www.amazon.com/Cosmetic-Dermatology-Principles-Practice-Second/dp/0071490620
• [9] Rawlings, A. V., et al. (2006). The effect of salicylic acid on corneocyte desquamation in vivo. The British journal of dermatology, 154(6), 1035-1040.
• [10] Del Rosso, J. Q., et al. (2006). Practical considerations in the management of acne vulgaris. The Journal of clinical and aesthetic dermatology, 2(2), 34-44. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928621/
• [11] Del Rosso, J. Q., et al. (2006). Practical considerations in the management of acne vulgaris. The Journal of clinical and aesthetic dermatology, 2(2), 34-44. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928621/
• [12] US Department of Health and Human Services. (2020, September 11). Sun Safety Tips. Centers for Disease Control and Prevention.