Topical salicylates

Salicylism and death have occurred following topical application. In an adult, 1 g of a topically applied 6% salicylic acid preparation will raise the serum salicylate level not more than 0.5 mg/dL of plasma the threshold for toxicity is 30-50 mg/dL. Higher serum levels are possible in children, who are therefore at a greater risk for salicylism. In cases of severe intoxication, hemodialysis is the treatment of choice (see Chapter 58). It is advisable to limit both the total amount of salicylic acid applied and the frequency of application. Urticarial, anaphylactic, and erythema multiforme reactions may occur in patients who are allergic to salicylates. Topical use may be associated with local irritation, acute inflammation, and even ulceration with the use of high concentrations of salicylic acid. Particular care must be exercised when using the drug on the extremities of patients with diabetes or peripheral vascular disease. 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

SALICYLATES - TOPICAL PORFIMER t risk of photosensitivity reactions when porfimer is co-administered with hydrochlorothiazide Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

P.G. Unna, a German dermatologist, was the first to describe the properties and use of salicylic acid. It has since been used for many decades as a keratolytic agent in concentrations of 3 to 6%. Salicylic acid is frequently utilized in topical acne preparations because of its comed-olytic effects. In addition, it facilitates the penetration of other topical agents. 

When treating acne vulgaris, topical and systemic therapies (if indicated) are initiated 2 to 4 weeks prior to peeling. Topical antibiotics and benzoyl peroxide based products can be used daily and discontinued 1 or 2 days prior to peeling. However, unless a deeper peel is desired, retinoids should be discontinued 7-10 days prior to salicylic acid peeling. Broad-spectrum sunscreens (UVA and UVB) should be worn daily (see Photo damage. Sunscreen section). 

In erythrosis 15% to 25% to 30% salicylic acid peeling should be performed at 3-week intervals for a total of three to four peelings (Fig. 17.14a, b). Suggested topical treatment between peeling includes 0,75% metronidazole cream once a day or 1-2% salicylic acid cream once a day and sunblock creams... 

In papulo-pustular rosacea 25-30% salicylic acid peeling is utilized in association with systemic treatment with metronidazole or antibiotics and topical treatment as for erythrosis (Figs. 1715,1716 and i/.i/)-... 

Topical therapy with 0.75 metronidazole or 1-2% salicylic acid... 

Topical analgesics sometimes are used for mild pain or as an adjunct to systemic therapy. There are limited data to support the use of salicylate-containing rubefacients (e.g., methyl salicylate and trolamine salicylate) or other counterirritants (e.g., menthol, camphor, and methyl nicotinate) in OA.32 See Chap. 57 for more information on these products when used for musculoskeletal disorders. 

Application of topical salicylates can lead to systemic effects, especially if the product is applied liberally. Repeated application and occlusion with a wrap or bandage also can increase systemic concentrations.41 Salicylate-containing counterirritants should be used with caution in patients in whom systemic salicylates are contraindicated, such as patients with severe asthma or aspirin allergy.42 Topical salicylates have been reported to increase prothrombin time in patients on warfarin and should be used with caution in patients on oral anticoagulants.43... 

Mason L, Moore RA, Edwards JE, et al. Systematic review of efficacy of topical rubefacients containing salicylates for the treatment of acute and chronic pain. Br Med J 2004 328 995. 

Keratolytic agents such as salicylic acid are often added to bath oil or shampoos (typically 3% to 4%) for scalp psoriasis.10 Salicylic acid can also be added to topical corticosteroid preparations to enhance steroid penetration (salicylic acid breaks down keratin). 

Sulfur, resorcinol, and salicylic acid are not as effective as other topical agents, but can be used as second-line therapies in the treatment of mild to moderate acne.12... 

While these agents may cause less skin irritation than benzoyl peroxide or the topical retinoids, several disadvantages exist. Sulfur preparations produce an unpleasant odor when applied to the skin, while resorcinol may cause brown scaling. And although rare, the possibility of salicylism exists with continual salicylic acid use.3,12... 

BPO = benzoyl peroxide AA = azelaic acid TR = topical retinoid SA = salicylic acid OA = oral antibiotic TA = topical antimicrobial... 

Topical rubefacients containing methyl salicylate, trolamine salicylate,... 

Mild acne usually is managed with topical retinoids alone or with topical antimicrobials, salicylic acid, or azelaic acid. 

Salicylic acid, sulfur, and resorcinol are second-line topical therapies. They are keratolytic and mildly antibacterial agents. Salicylic acid has comedolytic and antiinflammatory action. 

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