Advertisement

A review of toxicity from topical salicylic acid preparations

  • Raman K. Madan
    Affiliations
    Beth Israel Medical Center, Mount Sinai Health System, New York, New York

    Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author
  • Jacob Levitt
    Correspondence
    Reprint requests: Jacob Levitt, MD, Department of Dermatology, Mount Sinai School of Medicine, 5 E 98th St, 5th Floor, Box 1048, New York, NY 10029.
    Affiliations
    Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author
Published:January 27, 2014DOI:https://doi.org/10.1016/j.jaad.2013.12.005
      Topical salicylic acid is often used in dermatologic conditions because of its keratolytic, bacteriostatic, fungicidal, and photoprotective properties. The bioavailability of salicylic acid differs depending on the vehicle used and pH of transcellular fluids. Although rare, salicylic acid toxicity (salicylism) can occur from topical application. Physicians should be mindful of the potential for salicylism or even death from topically applied salicylic acid.

      Key words

      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tilo Grosser E.S.
        • FitzGerald G.A.
        Anti-Inflammatory, antipyretic, and analgesic agents.
        in: Brunton L.L. Goodman and Gilman's the pharmacological basis of therapeutics. 12th ed. McGraw-Hill Co, New York2011: 977-982
        • Daintith E.J.
        Aspirin.
        Oxford University Press, 2008 (Available from: URL) (Accessed August 17, 2012)
        • Palleros D.R.
        Experimental organic chemistry.
        John Wiley and Sons, New York2000
        • Lipster D.
        • Kragballe K.
        • Saurat J.H.
        Other topical medications.
        in: Bolognia J.L. Rapini R.P. Dermatology. 1st ed. Elsevier Limited, Philadelphia2003: 2062
        • Freeberg I.M.
        • Eisen A.Z.
        • Wolff K.
        • Austen K.F.
        • Goldsmith L.A.
        • Katz S.I.
        Fitzpatrick's dermatology in general medicine.
        6th ed. McGraw-Hill, New York2003
        • Hessel A.
        • Lin A.
        Agents used for treatment of hyperkeratosis.
        in: Wolverton S.E. Comprehensive dermatologic drug therapy. 1st ed. Saunders, Philadelphia2001: 671-674
        • Schwarb F.P.
        • Gabard B.
        • Rufli T.
        • Surber C.
        Percutaneous absorption of salicylic acid in man after topical administration of three different formulations.
        Dermatology. 1999; 198: 44-51
        • Taylor J.R.
        • Halprin K.M.
        Percutaneous absorption of salicylic acid.
        Arch Dermatol. 1975; 111: 740-743
        • Birmingham B.K.
        • Greene D.S.
        • Rhodes C.T.
        Systemic absorption of topical salicylic acid.
        Int J Dermatol. 1979; 18: 228-231
        • Benfeldt E.
        • Serup J.
        • Menné T.
        Effect of barrier perturbation on cutaneous salicylic acid penetration in human skin: in vivo pharmacokinetics using microdialysis and non-invasive quantification of barrier function.
        Br J Dermatol. 1999; 140: 739-748
        • Klimowicz A.
        • Farfal S.
        • Bielecka-Grzela S.
        Evaluation of skin penetration of topically applied drugs in humans by cutaneous microdialysis: acyclovir vs salicylic acid.
        J Clin Pharm Ther. 2007; 32: 143-148
        • Singh P.
        • Roberts M.S.
        Skin permeability and local tissue concentrations of nonsteroidal anti-inflammatory drugs after topical application.
        J Pharmacol Exp Ther. 1994; 268: 144-151
        • Long C.C.
        • Finlay A.Y.
        The finger-tip unit–a new practical measure.
        Clin Exp Dermatol. 1991; 16: 444-447
        • VonWeiss J.F.
        • Lever W.F.
        Percutaneous salicylic acid intoxication in psoriasis.
        Arch Dermatol. 1964; 90: 614-619
        • Higashi Y.
        • Kiuchi T.
        • Furuta K.
        Efficacy and safety profile of a topical methyl salicylate and menthol patch in adult patients with mild to moderate muscle strain: a randomized, double-blind, parallel-group, placebo-controlled, multicenter study.
        Clin Ther. 2010; 32: 34-43
        • Martin D.
        • Valdez J.
        • Boren J.
        • Mayersohn M.
        Dermal absorption of camphor, menthol, and methyl salicylate in humans.
        J Clin Pharmacol. 2004; 44: 1151-1157
        • Davis J.E.
        Are one or two dangerous? Methyl salicylate exposure in toddlers.
        Emerg Med. 2007; 32: 63-69
        • Torloni M.R.
        • Cordioli E.
        • Zamith M.M.
        • Hisaba W.J.
        • Nardozza L.M.
        • Santana R.M.
        • et al.
        Reversible constriction of the fetal ductus arteriosus after maternal use of topical diclofenac and methyl salicylate.
        Ultrasound Obstet Gynecol. 2006; 27: 227-229
        • Bell A.J.
        • Duggin G.
        Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis.
        Emerg Med (Fremantle). 2002; 14: 188-190
        • Heng M.C.
        Local necrosis and interstitial nephritis due to topical methyl salicylate and menthol.
        Cutis. 1987; 39: 442-444
        • Joss J.D.
        • LeBlond R.F.
        Potentiation of warfarin anticoagulation associated with topical methyl salicylate.
        Ann Pharmacother. 2000; 34: 729-733
        • Oualha M.
        • Dupic L.
        • Bastian C.
        • Bergounioux J.
        • Bodemer C.
        • Lesage F.
        Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication; a case report [in French].
        Arch Pediatr. 2012; 19: 1089-1092
        • Chodorowski Z.
        • Anand J.S.
        • Waldman W.
        Suicidal salicylate intoxications and unintentional percutaneous poisoning with salicylic ointment [in Polish].
        Przegl Lek. 2003; 60: 302-304
        • Yamamura S.
        • Kinoshita Y.
        • Kitamura N.
        • Kawai S.
        • Kobayashi Y.
        Neonatal salicylate poisoning during the treatment of a collodion baby.
        Clin Pediatr. 2002; 41: 451-452
        • Peyriere H.
        • Balmes N.
        • Rouanet I.
        • Mauboussin J.M.
        • Hillaire-Buys D.
        • Arich C.
        • et al.
        Acute salicylate intoxication after percutaneous absorption in an HIV patient treated for psoriasis.
        AIDS. 2002; 16: 1843-1844
        • Chiaretti A.
        • Schembri Wismayer D.
        • Tortorolo L.
        • Piastra M.
        • Polidori G.
        Salicylate intoxication using a skin ointment.
        Acta Paediatr. 1997; 86: 330-331
        • Germann R.
        • Schindera I.
        • Kuch M.
        • Seitz U.
        • Altmeyer S.
        • Schindera F.
        Life threatening salicylate poisoning caused by percutaneous absorption in severe ichthyosis vulgaris.
        Hautarzt. 1996; 47: 624-627
        • Brubacher J.R.
        • Hoffman R.S.
        Salicylism from topical salicylates: review of the literature.
        J Toxicol Clin Toxicol. 1996; 34: 431-436
        • Abdel-Magid E.H.
        • el-Awad Ahmed F.R.
        Salicylate intoxication in an infant with ichthyosis transmitted through skin ointment–a case report.
        Pediatrics. 1994; 94: 939-940
        • Maurer T.A.
        • Winter M.E.
        • Koo J.
        • Berger T.G.
        Refractory hypoglycemia: a complication of topical salicylate therapy.
        Arch Dermatol. 1994; 130: 1455-1457
        • Dwyer C.M.
        • McCloskey R.H.
        • Kerr R.E.
        Poisoning from topical salicylic acid.
        Postgrad Med J. 1994; 70: 146
        • Péc J.
        • Strmenova M.
        • Palencárová E.
        • Pullmann R.
        • Funiaková S.
        • Visnovský P.
        • et al.
        Salicylate intoxication after use of topical salicylic acid ointment by a patient with psoriasis.
        Cutis. 1992; 50: 307-309
        • Raschke R.
        • Arnold-Capell P.A.
        • Richeson R.
        • Curry S.C.
        Refractory hypoglycemia secondary to topical salicylate intoxication.
        Arch Intern Med. 1991; 151: 591-593
        • Galea P.
        • Goel K.M.
        Salicylate poisoning in dermatological treatment [letter].
        Arch Dis Child. 1990; 65: 335
        • Ward P.S.
        • Jones R.D.
        Successful treatment of a harlequin fetus.
        Arch Dis Child. 1989; 64: 1309-1311
        • Shupp D.L.
        • Schroeter A.L.
        An unusual case of salicylate toxicity [letter].
        J Am Acad Dermatol. 1986; 15: 300-301
        • Treguer H.
        • Le Bihan G.
        • Coloignier M.
        • Le Roux P.
        • Bernard J.P.
        Salicylate poisoning by local application of 20% salicylic acid petrolatum to a psoriatic patient [in French].
        Nouve Presse Med. 1980; 9: 192-193
        • Davies M.G.
        • Briffa D.V.
        • Greaves M.W.
        Systemic toxicity from topically applied salicylic acid.
        Br Med J. 1979; 1: 661
        • Luderschmidt C.
        • Plewig G.
        Chronic percutaneous salicylic acid poisoning [in German].
        Hautarzt. 1975; 26: 643-646
        • Lindsey C.P.
        Two cases of fatal salicylate poisoning after topical application of an antifungal solution.
        Med J Aust. 1968; 1: 353-354

      Linked Article

      • Correction
        Journal of the American Academy of DermatologyVol. 71Issue 1
        • Preview
          Madan RK, Levitt J. A review of toxicity from topical salicylic acid preparations. J Am Acad Dermatol 2014;70:788-92.
        • Full-Text
        • PDF