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Benzoyl Peroxide vs Salicylic Acid for Acne Treatment

Benzoyl peroxide (BPO) is a widely-used over-the-counter treatment for acne. I remember using it as a teenager and HATING it because it made my skin painful, red, irritated, and caused unsightly peeling and flaking. 

These are common side effects, and others include itching, crusting, blistering, and severe redness. 

My husband has been dealing with acne recently and he has always had oily skin. We've been working with our acupuncturist to address internal root causes that are likely contributing to his case, but I have also wanted him to start using a full skincare regimen to treat his acne topically. 

Also: ever since I had to take a round of antibiotics (for the first time in almost a decade) earlier this summer I have been getting minor breakouts on my chest (argh!) I am still doing a lot of work to take care of my gut microbiome (read my full protocol here) which should allow the breakouts to subside, but I've also wanted something topical to speed things along!

Why I am NOT using Benzoyl Peroxide

Since I am a neuroscientist I always like to read papers published in the scientific literature to help me form opinions and make the best decisions for the health of myself and my family. Here are a few things I learned when I started researching benoyl peroxide as an acne treatment:

1. It is a relatively modern substance, having been first manufactured in 1905 as an industrial chemical. It wasn't used for medical purposes until 1930.

2. Benzoyl peroxide is a free-radical generating compound. Do you know what free radical exposure does to our skin? It causes premature signs of aging. In fact, that's what many anti-aging skincare products do - fight the effects of free radical exposure! This is enough reason alone for me to put this on my "things to permanently avoid" list. 

3. Because it is a free-radical generating compound, in scientific research studies on animals it is used to promote the growth of skin tumors and expedite the conversion of benign papillomas to malignant carcinomas. For example, this paper looks at how iron status affects tumor growth and malignancy, and to speed up the process they used several different free-radical generating compounds, including benzoyl peroxide. While there's no definitive research to show that it does this in humans, uh, I'll pass just the same, especially since there are safer alternatives!

4. Animal studies have shown that repeated high-dose exposure is linked to harmful reproductive system effects (decreased testis and epididymis size, abnormal cell proliferation of the endometrial lining of the uterus, reduced offspring weight to mothers chronically exposed). Again, this has never been demonstrated in humans, and the exposure rates are HIGH in these studies, but it still gives me pause. 

5. Some scientists think that allergic reaction to benzoyl peroxide is vastly underreported, since users may mistake the early signs of allergic contact dermatitis for the common skin irritation and redness that BPO causes and will thus continue use thinking it will go away over time. This can lead to a reaction so severe that hospitalization is required in rare circumstances (source). 

Plus, as is the case with the majority of skincare products on the market in the U.S., most products using benzoyl peroxide are formulated with ingredients I will never allow on my skin, including PEGs (which are almost always contaminated with some very dangerous known human carcinogens 1,4-dioxane and ethylene oxide), harsh surfactants, fragrance, and other irritating or potentially harmful ingredients. 

Salicylic Acid As A Safer Acne Treatment

Here is what I learned when I set out to research salicylic acid as a safer alternative to benzoyl peroxide:

1. Salicylic acid has a very long history of use (~2,000 years!) in humans for a wide range of skin conditions besides acne.

2. It can be naturally sourced from a range of plants, including willow bark, sweet birch, and wintergreen. 

3. It has multiple beneficial functions when used on the skin: it is anti-inflammatory, antibacterial, soothing, an exfoliator, decreases overproduction of sebum (oil), and, of course, is anti-acne.

4. This animal study used simulated solar light to cause skin cancer, and the researchers found that salicylic acid had a protective effect, reducing the rate of cancer caused by the light exposure. 

Sounds a lot better than bezoyl peroxide, doesn't it?! 

Word of caution: just like I described above, most products on the market using salicylic acid for acne are in formulations that contain known or potentially harmful ingredients. I always check the Environmental Working Group's (EWG) Skin Deep Database to learn about ingredient safety. This tool draws from the available scientific evidence to rate products and individual ingredients with a safety rating ranging from 1 (safest) to 10 (holy moly, DANGER!) using handy color-coding system (green means go, red means avoid!)

If you haven't yet switched your skincare products to safer options, I highly recommend looking up what you are using currently. Find the worst offenders and prioritize changing those out first! I can help you if you fill out my skincare consultation questionnaire

I recommend phasing out products that contain parabens and/or phthalates ("fragrance" or "parfum") first, read more about the negative health consequences of those ingredients here

Countercontrol Acne Treatment Regimen

Beautycounter, my favorite line for safe and high performing skincare and cosmetics, has just released a brand new acne treatment line called Countercontrol. As a consultant I learned about this new line months ago and it is one of the reasons why I started reading about acne-fighting ingredients.

Countercontrol meets my strict standards for safe, non-toxic skincare and I am so happy that my husband has something to use to help clear his skin up and control oil production!

One of the many reasons why I love Beautycounter is their commitment to product SAFETY first and foremost. Then, they focus on producing ultra high-performing products that are just as good or better than popular toxic conventional options. 

They have an impressive thing called The Never List which includes over 1500 harmful or questionable ingredients that are banned from their products. This includes the over 1400 ingredients that are restricted or banned by the European Union for use in skincare and cosmetics plus additional ingredients screened by their scientists and deemed to be of concern. 

Countercontrol Proven Results

In an independent consumer study, after 4 weeks of use:

  • 100% said skin clarity improved

  • 100% stated skin feels healthier

  • 95% said skin looks clearer

  • 95% said skin looks less red

I will share an update from myself and my husband Andy (with before/after photos) after we have had a chance to use the products for at least a month. Stay tuned!

Beneficial Botanical Ingredients in Countercontrol 

In addition to using naturally-derived salicylic acid as the active ingredient (from Galutheria procumbens, aka wintergreen), there are a couple of other interesting ingredients that caught my attention:

Rosebay Willow (Epilobium angustifolium; also known as fireweed) - This is a traditional medicinal plant used around the world and that has been shown in scientific studies to have a wide range of pharmacological and therapeutic effects, including antioxidant, anti-proliferative (stops the multiplication of malignant cells), anti-inflammatory, antibacterial, and anti-aging. "it has also been used topically as a cleansing, soothing, antiseptic, and healing agent to treat minor burns, skin rashes, ulcers, and infections, and for treatment of inflammation of the ear, nose, and throat" (source)

Quince (Cydonia oblongata) - this is one powerhouse medicinal plant! It is part of the herbal pharmacopeia of both Chinese medicine and Ayurvedic medicine and science has shown that its constituents possess a wide range of pharmacological activities relevant to skincare: antioxidant, antibacterial, anti-fungal, anti-inflammatory (source). The leaf extract (which is what is in the Countercontrol line) has also been shown to have a UV protective effect

Squalene (from olives, not shark livers like other brands) - this is found in quite a few Beautycounter products. It is actually one of the intermediate metabolites in the synthesis of cholesterol in our bodies, and it is found in high concentrations in our skin surface lipids and is believed to play a critical role in preventing free radical oxidative damage to the skin from things like UV ray exposure and unavoidable environmental pollutants. In skincare it is an emollient, antioxidant, for hydration, and antitumor properties. Animal studies have shown that squalene effectively inhibits chemically-induced skin tumor formation (source 1, 2)

Phytic Acid (from green rice) - another potent antioxidant that helps refine skin texture when used topically.  

Aloe Vera & Witch Hazel - well-known anti-inflammatory botanicals that can promote healing. Both also possess antioxidant properties. 

and since we are talking about these beneficial botanical ingredients Wintergreen (Galutheria procumbens) contains "considerable quantities" of antioxidant polyphenols (from proanthocyanidins and flavonoids) that also show anti-inflammatory activity. (source)

How To Use The Countercontrol Acne Treatment Line

 Beautycounter Countercontrol safe, non-toxic acne treatment line

First things first, what constitutes a complete skincare regimen? 

  1. Cleanse
  2. Prep (tone)
  3. Treat (serum, or in this case, acne treatment)
  4. Protect (moisturize)

I will admit that I did not ever use a complete skincare regimen until 2016 at age 32. I thought it was a waste of time (and money) but I can tell you that I have learned that it is hugely beneficial and I have seen my complexion brighten, fine lines reduced, dark spots fade, and smoothness and texture improve. 

Countercontrol is a complete skincare regimen that is meant to be used twice a day, ever day for optimal results.

CLEANSE

Countercontrol Clear Pore Cleanser a gentle daily exfoliating cleanser that effectively removes oil, makeup, and other impurities without harsh surfactants that can strip skin of moisture. The formula contains eco-friendly biodegradable jojoba beads to gently slough away dead skin cells without polluting our waterways and harming marine life the way conventional exfoliating microbeads do. 

PREP

Countercontrol Instant Matte Toner is an alcohol-free mattifying toner that removes residual impurities, eliminates excess oil, and minimizes the appearance of pores.

TREAT

Countercontrol All Over Acne Treatment is a daily, all-over treatment that helps clear existing blemishes and addresses the main causes of acne to prevent future breakouts from forming.

Countercontrol SOS Acne Spot Treatment is a fast-acting, invisible gel formula with maximum strength salicylic acid to penetrate pores to reduce blemishes and clear skin WITHOUT over-drying.

PROTECT

Countercontrol Matte Effect Gel Cream is an oil-free moisturizer and has an innovative cream-to-gel formula. It i non-greasy and controls oil for up to eight hours. It also makes an EXCELLENT primer underneath makeup!

You can get the entire line for $20 off (13% discount) if you buy it bundled as a complete set

What if I have oily skin without blemishes? 

You will want to use the following: 

  1. Clear Pore Cleanser (cleanse)

  2. Instant Matte Toner (prep)

  3. All Over Acne Treatment (treat)

  4. Matte Effect Gel Cream (protect)

The "All Over Acne Treatment" is still good for your skin even when acne isn't present - remember above all of the benefits of salicylic acid and all the botanical ingredients in this line? The line as a whole targets oil overproduction which is one of the root causes of acne, but you will still benefit even if you don't have acne. 

What if I don't have regular acne? 

 Two hero products from the line that almost EVERYONE will love!

Two hero products from the line that almost EVERYONE will love!

Do you ever get that random, annoying, out-of-the-blue breakout? If you're a woman, maybe that's during ovulation or menstruation, or if you deal with food intolerances they may crop up if you ate something you shouldn't have. 

Either way, I think that pretty much everyone should have the SOS Acne Spot Treatment in their emergency medicine cabinet! Unless you are a unicorn who never ever has a blemish. In which case....what is your secret?! I need to know. 

You can use the SOS spot treatment with any skincare regimen after the treat step (so, for most other regiments that is the serum) and before you apply your moisturizer. 

And like I mentioned earlier, I think that a LOT of people are going to like the Matte Effect Gel Cream since it makes an excellent primer to go underneath foundation. I have enjoyed using it as a daytime moisturizer in the oppressive Memphis humid summer heat to keep my skin feeling fresh and non-greasy. 

Is Salicylic Acid Safe During Pregnancy and Breastfeeding?

Always talk to your qualified healthcare provider if you have concerns about the safety of anything during pregnancy. 

That said, here is what scientists have to say on the matter from a recent 2018 paper published in Regulatory Toxicology and Pharmacology, which is the official journal of the International Society for Regulatory Toxicology and Pharmacology, which, like the name implies, interprets scientific knowledge to influence regulatory decisions to protect human health. 

The article title answers the question (emphasis mine): A kinetic-based safety assessment of consumer exposure to salicylic acid from cosmetic products demonstrates no evidence of a health risk from developmental toxicity

You can read the full text if you are curious, but here is the bottom line: 

The pharmacokinetic-based safety assessment of the risk of teratogenicity described here results in a margin of safety which strongly supports that salicylic acid-containing cosmetic products are safe for pregnant women. [...] The available human data show that the systemic exposure from dermal exposure to salicylic acid-containing cosmetic formulations is considerably less than that after oral intake of acetylsalicylic acid (aspirin) up to the maximum recommended therapeutic dose of 4000 mg/day (equivalent to 51 mg/kg bw salicylic acid) which has not resulted in any evidence for adverse developmental effects in humans.
— Labib R., et al, 2018

 

Here are a few more quotes for good measure:

"[Topically applied salicylic acid is] undetectable from up to 25% in normal skin (depends on vehicle, pH, strength, and quantity applied). Levels might be higher when applied to damaged skin" (source) - Countercontrol uses it at a strength of 2%. 

"We recommend the use of topical medications as first-line treatment for acne vulgaris in pregnant and lactating women [including] salicylic acid. [...] Salicylic acid has been used as an over-the-counter dermatological agent for many years with no reports of teratogenicity. Its oral form, aspirin, is being  used  in  low  dosages  to prevent pre-eclampsia, and  this  affirms  its  safety.  There  is  a  theoretical  risk  of Reye’s  syndrome  with  use  of  aspirin  in  breastfed  infants, but this is unlikely with topical salicylic acid because of minimal skin absorption, especially if use is limited to small areas of the skin." (source)

 

And here is Beautycounter's official response to this question:

Beautycounter uses salicylic acid (SA) in our acne products at levels allowed by the US FDA. At these SA levels, no warnings for pregnant or breastfeeding women are required by the FDA for topical acne treatment. Salicylic acid is found in our normal diets at levels nearly 25% of what we would receive from a potential acne treatment. Salicylic acid occurs in common fruits such as apples, oranges, plums, and grapes, which accounts for its presence in most wines. Salicylic acid has been quantitatively detected in many foods, including whole tomatoes, cinnamon, oregano, thyme, red wine, beer, honey, licorice, raisins, barley, blueberry, cumin, and other spices. In fact from a survey of vegetable soup, it was found that the organic soup tested had a salicylic acid concentration of 6 times the amount than found in non-organic soup.

Custom Skincare Consultations

If you are looking for a customized skincare regimen suggestion please take a few moments to fill out my skincare consultation questionnaire. Some of my clients benefit from a mix-and-match approach so that they can address multiple skin concerns at once (like anti-aging + oily skin, or dry skin + dark spots, etc.) rather than going all in with one line. 

I am here to  help, so please fill it out if you'd like personalized recommendations! Please know that I do not copy/paste suggestions - I read every detail you provide and give you my best suggestions based on all of your skincare concerns. As such it can take me 24-48 hours to respond. 

 Beautycounter Countercontrol: safe, non-toxic acne treatment with salicylic acid and beneficial botanicals

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