Salicylic Acid during Pregnancy: Is there a Risk?

Firstly, it is crucial to emphasise the need for caution during this unique period of life and always seek advice from a healthcare professional before using a salicylic acid product to ensure your safety and that of your baby. Based on the evidence currently available and the report from the Scientific Committee on Consumer Safety (SCCS), it is possible to apply safely throughout pregnancy products containing salicylic acid, when used within the concentration limits specified by the Cosmetic Regulation (Annex III and V).

Salicylic acid is classified by the Food and Drug Administration (FDA) as a Category C drug for pregnancy.

A number of studies have been published in which researchers have examined the outcomes of women who took low doses of oral acetylsalicylic acid during pregnancy and found no adverse events, such as congenital malformations, haemorrhagic complications or premature birth (miscarriage).

However, at high concentrations, if large areas of skin are treated (> 20%) or when applied under occlusion, salicylates have the potential to cross the placental barrier to reach the foetus. Yet, an overdose in the last trimester of pregnancy can lead to foetal death, antepartum and postpartum bleeding, or prolonged pregnancy and labour. Therefore, further research is needed to determine if there are any harmful risks to the developing baby.

However, no studies have been conducted regarding the topical use of salicylic acid during pregnancy, thus preventing a concrete recommendation. On the other hand, it has been shown that a small proportion of salicylic acid can be absorbed to some extent by the skin. Therefore, even though it is unlikely to pose a risk to the developing baby, doctors recommend that salicylic acid-based solutions should be used with caution on normal skin.

Similarly, there are very few studies conducted on the topical use of salicylic acid in breastfeeding women, whose main concern is the systemic absorption of active ingredients and their subsequent excretion into breast milk which could potentially affect neonatal growth and development. HIGGINS H. W. & co. have stated that salicylic acid chemical peels can be safely used during breastfeeding, as there is little risk of significant systemic absorption. Based on the data provided, there are certain things to bear in mind.

• Use salicylic acid at a concentration lower than 2% ;

• Maintain a topical use only, as salicylic acid is irritating to the mucous membranes;

• Restrict the use of salicylic acid to a topical application, on small areas of the skin;

• Never apply salicylic acid to damaged skin, as this could increase its skin penetration;

• Apply as a precautionary measure on a daily basis a sunscreen when using products containing BHA due to its keratolytic action, even though it is a low-level photoprotective agent;

• Selecting alternative peelings, such as those with lactic acid or glycolic acid, which are classified in category B by the FDA, given that the use of salicylic acid peeling is not recommended during pregnancy.