Does Salicylic Acid Cause Purging? Dermatologist Q&A

Dr Dray

AI-assisted summary of Does Salicylic Acid Cause Purging? Dermatologist Q&A — original source. Check the original for full context.

Source published: 2026-09-19

Key ideas

True clinical purging is widely misunderstood and clinically rare, occurring almost exclusively with oral isotretinoin rather than topical retinoids or salicylic acid, where new breakouts typically indicate skin barrier irritation. (1:22)
Rinse-off salicylic acid cleansers successfully exfoliate the skin because lipophilic salicylic acid penetrates sebum-rich follicles rapidly and leaves an active microscopic film via coacervation. (7:14)
While oral aspirin can inhibit follicular sulfotransferase and dampen topical minoxidil activation, topical salicylic acid has no proven adverse effect on minoxidil efficacy, and oral minoxidil is metabolized in the liver unaffected by NSAIDs. (8:14)
Non-invasive skin-tightening modalities—such as radiofrequency, ultrasound, and micro-coring—provide measurable improvement for mild post-weight-loss laxity, especially in younger individuals with preserved collagen reserves. (3:52)

Detailed notes

## Bulletin - [01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) True clinical purging is widely misunderstood and clinically rare, occurring almost exclusively with oral isotretinoin rather than topical retinoids or salicylic acid, where new breakouts typically indicate skin barrier irritation. - [07:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=434s) Rinse-off salicylic acid cleansers successfully exfoliate the skin because lipophilic salicylic acid penetrates sebum-rich follicles rapidly and leaves an active microscopic film via coacervation. - [08:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=494s) While oral aspirin can inhibit follicular sulfotransferase and dampen topical minoxidil activation, topical salicylic acid has no proven adverse effect on minoxidil efficacy, and oral minoxidil is metabolized in the liver unaffected by NSAIDs. - [03:52](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=232s) Non-invasive skin-tightening modalities—such as radiofrequency, ultrasound, and micro-coring—provide measurable improvement for mild post-weight-loss laxity, especially in younger individuals with preserved collagen reserves.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=0s) Colloidal oatmeal is an FDA-regulated OTC drug standard permitted to make skin protectant claims, whereas Avena sativa oat extract is classified as a cosmetic ingredient barred from therapeutic claims. - [01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) True acne purging is virtually never seen with topical retinoids; in clinical practice, it is essentially restricted to nodulocystic acne flares during the first month of oral isotretinoin treatment. - [01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) New breakouts emerging after switching between topical retinoids like tazarotene and tretinoin are generally caused by non-specific irritation, barrier compromise, or vehicle ingredient sensitivity rather than purging. - [02:38](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=158s) The true exfoliating potency of a 10% glycolic acid formulation depends primarily on product pH and free acid value rather than the concentration percentage listed on the label. - [03:52](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=232s) Patients in their twenties respond significantly better to non-invasive tightening procedures like radiofrequency and ultrasound due to higher baseline collagen and elastin reserves compared to older patients. - [06:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=374s) Venous lakes on the lips develop predominantly from cumulative lifetime ultraviolet radiation degrading the connective tissue support surrounding microvasculature, leading to permanent vascular dilation. - [07:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=434s) Salicylic acid cleansers deliver genuine keratolytic benefits because salicylic acid is oil-soluble and coacervation deposits an active film onto the skin even during short contact and rinsing. - [08:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=494s) Topical minoxidil is an inactive prodrug that requires activation by the follicular enzyme sulfotransferase (SULT1A1), which can be inhibited by daily low-dose oral aspirin. - [09:18](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=558s) No clinical evidence shows that topical salicylic acid inhibits minoxidil efficacy, and patients routinely achieve solid hair-growth results while using salicylic acid dandruff shampoos alongside minoxidil. - [10:35](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=635s) Breakouts experienced after introducing topical salicylic acid are almost always caused by barrier disruption and underlying inflammation rather than accelerated purging. - [11:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=674s) Oral minoxidil is converted to its active sulfate form by sulfotransferase in the liver rather than the scalp, rendering follicular sulfotransferase inhibition irrelevant. - [11:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=674s) Retrospective clinical data demonstrates that patients taking systemic aspirin or NSAIDs achieve equivalent hair density and count improvements on oral minoxidil compared to non-users.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=0s) Colloidal Oatmeal vs. Oat Extract

In response to a viewer recovering from a severe, full-body hive outbreak triggered by an allergic reaction to a new medication, Dr. Dray addresses whether colloidal oatmeal can be incorporated safely into a daily routine and how it differs from oat extract. While using colloidal oatmeal every day is completely safe, Dr. Dray points out a practical reality: it is virtually impossible to rely exclusively on colloidal oatmeal unless someone plans on buying a plain box of powdered bath treatment to reconstitute in water. In everyday life, people still require broad-spectrum sunscreen and standard moisturizers, meaning their skin will inevitably come into contact with other cosmetic ingredients.

The distinction between colloidal oatmeal and oat extract (*Avena sativa*) comes down to strict regulatory standards and processing methods: - **Colloidal Oatmeal:** An over-the-counter (OTC) drug regulated by the FDA. It is legally permitted to make therapeutic drug claims as a skin protectant. It is manufactured by finely grinding whole oats and processing them down to an exact, regulated particle size that disperses evenly in water or lotions. - **Avena Sativa (Oat) Extract:** Classified strictly as a cosmetic ingredient. It is a concentrated liquid or powder isolated from specific portions of the oat plant. Brands can advertise it as "soothing" or claim that it "improves the look of dry skin," but they are prohibited by law from making formal medical treatment claims.

[01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) Retinoid Purging: Tazarotene vs. Tretinoin

When a viewer describes switching from long-term tazarotene (Tazorac) to tretinoin 0.05% due to persistent sensitization, only to start breaking out, Dr. Dray dispels the pervasive skincare myth of "purging." While skin turnover theoretically accelerates with topical retinoids, true clinical purging rarely unfolds the way consumers imagine. In clinical dermatology practice, true purging is almost exclusively observed when patients with nodulocystic acne begin oral isotretinoin (Accutane), where deep, preexisting inflammatory lesions are rapidly forced to the surface during the first month of therapy.

Switching between topical retinoids should not suddenly bring latent acne erupting to the surface. Instead, breakouts during a transition are far more likely driven by non-specific irritation. Although tazarotene is generally considered more potent and irritating than tretinoin, individual skin tolerances vary widely. The new breakouts can stem from barrier impairment caused by tretinoin itself, sensitivity to inactive vehicle ingredients (emulsifiers, preservatives, or bases) in the new formulation, or external factors entirely unrelated to the retinoid change.

[02:38](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=158s) Using 10% Glycolic Acid Sprays on the Body

Evaluating whether a 10% glycolic acid spray is overly harsh for body skin depends on individual skin tolerance and chemical formulation. Dr. Dray frequently recommends 10% glycolic acid body lotions for rough, bumpy skin conditions like keratosis pilaris (KP). At this concentration, the alpha hydroxy acid (AHA) provides robust humectant hydration, smooths textural irregularities, and accelerates the clearance of post-inflammatory hyperpigmentation.

However, the percentage on the label tells only half the story. The exfoliating potency of glycolic acid is heavily dictated by product formulation, particularly its pH level: - Lower pH levels yield a higher "free acid value," dramatically increasing keratolytic potency and irritation potential. - A buffered formula with a higher pH will deliver gentler exfoliation and humectant benefits with lower irritation. - Because of these chemical dynamics, two distinct 10% glycolic acid products from different brands can behave in completely different ways on the skin.

[03:52](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=232s) Skin Tightening Options After Significant Weight Loss

A 27-year-old viewer who lost nearly 100 pounds using a GLP-1 medication asked about in-office cosmetic procedures to address mild skin laxity across the mid-abdomen. While emphasizing that only an in-person examining provider can tailor a treatment plan, Dr. Dray notes that youth is a distinct advantage: a 27-year-old possesses a significantly more robust reservoir of collagen and elastin, yielding far better responses to non-invasive tightening modalities than someone over 40.

Dr. Dray outlines the non-surgical and minimally invasive treatment landscape for mild body laxity:

```mermaid flowchart TD accTitle: Skin Tightening Modality Matrix accDescr: Flowchart categorizing skin tightening procedures by mechanism of action, depth, and indications.

subgraph RF["Radiofrequency (Thermal Remodeling)"] A["Thermage (Monopolar RF)"] -->|"Deep dermis heating"| Tight["Collagen induction & tightening"] B["Morpheus8 (RF + Microneedling)"] -->|"Deeper pin penetration"| PromLax["Treats moderate skin laxity"] end

subgraph US["Ultrasound (Focal Acoustic Energy)"] C["Ultherapy & Sofwave"] -->|"Target deep tissue planes"| Lift["Lifting & gradual smoothing"] end

subgraph Resurf["Resurfacing & Mechanical Coring"] D["Fraxel Laser"] -->|"Upper dermis remodeling"| Texture["Improves crepey surface quality"] E["Ellacor Micro-Coring"] -->|"Excises micro-tissue cores"| Wound["Wound contraction with low downtime"] end ```

- **Thermage (Monopolar Radiofrequency):** Uses bulk heating in the deeper dermal planes to stimulate neocollagenesis, creating a gradual tightening effect without puncturing the skin. - **Morpheus8 (Radiofrequency Microneedling):** Combines physical micro-pins with radiofrequency energy to penetrate deeper into the dermis and subdermal fat, providing more substantial contraction for noticeable laxity. - **Ultrasound (Ultherapy and Sofwave):** Delivers micro-focused ultrasound energy to deeper structural tissues, generating a lifting and structural smoothing effect over several months. - **Resurfacing Lasers (e.g., Fraxel):** Focuses primarily on superficial skin architecture rather than deep suspension, making it optimal for crepey texture and mild superficial laxity. - **Micro-Coring (Ellacor):** An energy-free mechanical procedure that removes thousands of microscopic columns of skin tissue via hollow needles, inducing a direct wound-healing contraction that tightens lax skin with minimal recovery downtime.

[06:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=374s) Venous Lakes on the Lips and Sun Damage

Addressing whether venous lakes on the lips stem from sun damage, Dr. Dray confirms that cumulative ultraviolet (UV) radiation is indeed the primary culprit. Chronic sun exposure breaks down the structural collagen and elastin support surrounding lip microvasculature. Over decades, this connective tissue degradation causes blood vessel walls to lose elasticity and dilate permanently into dark blue or purple soft papules known as venous lakes.

The lower lip is uniquely susceptible due to its anatomical protrusion, which catches direct, intense UV exposure throughout a person's lifetime. While long-term actinic damage is the dominant factor, other contributors include intrinsic biological aging, genetic vascular predisposition, and localized physical trauma—such as chronic lip biting, prior dental or cutaneous surgery, or "being in a bar fight."

[07:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=434s) Exfoliation Efficacy of Salicylic Acid Cleansers

Responding to skepticism that rinse-off salicylic acid (beta hydroxy acid, or BHA) cleansers are merely "expensive water" that washes down the drain, Dr. Dray clarifies that these cleansers genuinely exfoliate. Because salicylic acid is oil-soluble (lipophilic), it rapidly penetrates into the sebum-rich environment of the hair follicle even during a brief lather.

Furthermore, cleansers deposit active ingredients via a physicochemical process called **coacervation**, in which polymer and surfactant interactions leave a microscopic film of the active ingredient behind on the stratum corneum after water rinsing: - Rinse-off cleansers function like short-contact therapy, offering lower overall irritation compared to leave-on serums and toners. - Although results take longer to appear than with leave-on treatments, salicylic acid washes effectively clear closed comedones, reduce inflammatory breakouts, speed up superficial hyperpigmentation fading, and help manage cutaneous viral warts.

[08:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=494s) Salicylic Acid, Aspirin, and Minoxidil Activation

Dr. Dray addresses viewer confusion regarding a biological pathway involving salicylic acid, minoxidil, and the sulfotransferase enzyme. Viewers often conflate topical salicylic acid with systemic aspirin (acetylsalicylic acid).

Topical minoxidil used for androgenetic alopecia is a prodrug; it has no hair-stimulating properties on its own. It requires activation in the outer root sheath of the hair follicle by the enzyme **sulfotransferase (SULT1A1)**, which converts it into its active metabolite, minoxidil sulfate: - Individuals with naturally low follicular sulfotransferase levels do not efficiently convert the molecule, explaining why a substantial subset of patients fail to respond to topical minoxidil. - Clinical research indicates that daily low-dose oral aspirin can inhibit follicular sulfotransferase activity, blunting the clinical efficacy of topical minoxidil. - Dr. Dray sets up the core scientific distinction: while oral acetylsalicylic acid (aspirin) can suppress this enzymatic activation, questions remain about whether topical salicylic acid products share the same interfering effect on the scalp.

[09:18](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=558s) Topical Salicylic Acid vs. Topical Minoxidil

Dr. Dray addresses the common question of whether salicylic acid interferes with the effectiveness of topical minoxidil. Chemically, salicylic acid is very similar to aspirin metabolites, leading to theoretical concerns that it might reduce minoxidil's efficacy in the same manner observed with low-dose daily aspirin. However, she clarifies that she has never encountered any actual research evaluating the concurrent application of topical salicylic acid and topical minoxidil for androgenetic alopecia.

Prior to discussions in recent years regarding low-dose daily aspirin impairing topical minoxidil response, nobody raised concerns about combining salicylic acid and minoxidil. Dr. Dray notes that she has worked with numerous patients who regularly use salicylic acid dandruff shampoos alongside minoxidil and continue to achieve solid hair-growth results. While patients who feel anxious about the combination are free to separate them, there is simply no convincing clinical or objective evidence suggesting that salicylic acid is contraindicated or that the two topicals cannot work synergistically.

- Salicylic acid is structurally related to aspirin metabolites, which gave rise to the theoretical interaction. - No direct research demonstrates reduced efficacy when topical salicylic acid is applied alongside topical minoxidil. - Real-world clinical experience shows that patients using salicylic acid shampoos for dandruff still experience successful hair growth with minoxidil.

---

[10:35](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=635s) Can Salicylic Acid Cause Purging?

Turning to another viewer's question about whether salicylic acid induces a "purging" phase, Dr. Dray explains that while salicylic acid chemically exfoliates and accelerates cellular turnover, the fear that topicals force a wave of deep acne to the surface is largely misplaced. True purging is almost exclusively observed clinically with oral isotretinoin (Accutane) in individuals suffering from nodular cystic acne, where a marked acne flare can occur during the first month of treatment.

Dr. Dray emphasizes that patients routinely overestimate both the reality and severity of skincare purging. In the vast majority of cases where somebody experiences breakouts after introducing a new topical exfoliating product like salicylic acid, the issue is skin barrier irritation and inflammation rather than a genuine biological purge.

---

[11:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=674s) Oral Minoxidil, Liver Sulfotransferase, and NSAIDs

Dr. Dray explores the nuanced relationship between minoxidil activation pathways and salicylic acid or NSAIDs, comparing the topical and oral routes of administration. While low-dose oral aspirin has been shown to reduce the efficacy of topical minoxidil by potentially dampening sulfotransferase activity in the hair follicle itself, oral minoxidil functions entirely differently. Minoxidil is a prodrug requiring sulfotransferase enzyme conversion to minoxidil sulfate; with the oral formulation, this activation takes place systemically in the liver rather than at the scalp level.

```mermaid flowchart TD accTitle: Minoxidil Activation Pathways accDescr: Diagram comparing the activation sites of topical versus oral minoxidil and potential interactions with NSAIDs.

subgraph TOPICAL["Topical Route"] TM["Topical Minoxidil"] -->|"Enzyme activation"| FS["Follicular Sulfotransferase (Scalp)"] FS --> TA["Active Minoxidil Sulfate"] ASP["Low-Dose Aspirin / NSAIDs?"] -.->|"May inhibit enzyme"| FS end

subgraph ORAL["Oral Route"] OM["Oral Minoxidil"] -->|"First-pass metabolism"| LS["Hepatic Sulfotransferase (Liver)"] LS --> OA["Active Minoxidil Sulfate"] OA --> HF["Delivered to Hair Follicles"] end ```

Because oral minoxidil is metabolized in the liver before reaching the scalp, local follicular sulfotransferase levels are irrelevant. A retrospective study evaluating hair counts and density in patients on oral minoxidil revealed that those taking aspirin or related medications responded just as well as non-users, showing no statistical difference in hair density outcomes. Consequently, dermatologists do not advise patients needing systemic NSAIDs or aspirin to discontinue them when taking oral minoxidil. Furthermore, using topical salicylic acid poses zero threat to oral minoxidil, as a topical wash or serum cannot impair the liver's enzymatic machinery.

- Oral minoxidil is activated in the liver by hepatic sulfotransferase, bypassing follicular enzymatic limitations. - Retrospective clinical data confirmed no decrease in hair counts or density among patients taking oral minoxidil while on aspirin or NSAIDs. - Topical salicylic acid has no systemic influence on hepatic minoxidil metabolism. - Dr. Dray signs off with her customary reminder: "Don't forget sunscreen and subscribe."

## Notable quotes > [00:04](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=4s) it is virtually impossible to rely exclusively on colloidal oatmeal unless someone plans on buying a plain box of powdered bath treatment to reconstitute in water. — Dr. Dray

> [01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) true clinical purging rarely unfolds the way consumers imagine. — Dr. Dray

> [01:22](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=82s) The new breakouts can stem from barrier impairment caused by tretinoin itself, sensitivity to inactive vehicle ingredients (emulsifiers, preservatives, or bases) in the new formulation, or external factors entirely unrelated to the retinoid change. — Dr. Dray

> [02:38](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=158s) two distinct 10% glycolic acid products from different brands can behave in completely different ways on the skin. — Dr. Dray

> [03:52](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=232s) a 27-year-old possesses a significantly more robust reservoir of collagen and elastin, yielding far better responses to non-invasive tightening modalities than someone over 40. — Dr. Dray

> [06:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=374s) being in a bar fight. — Dr. Dray

> [07:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=434s) expensive water

> [07:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=434s) Because salicylic acid is oil-soluble (lipophilic), it rapidly penetrates into the sebum-rich environment of the hair follicle even during a brief lather. — Dr. Dray

> [09:18](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=558s) there is simply no convincing clinical or objective evidence suggesting that salicylic acid is contraindicated or that the two topicals cannot work synergistically. — Dr. Dray

> [10:35](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=635s) In the vast majority of cases where somebody experiences breakouts after introducing a new topical exfoliating product like salicylic acid, the issue is skin barrier irritation and inflammation rather than a genuine biological purge. — Dr. Dray

> [11:14](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=674s) using topical salicylic acid poses zero threat to oral minoxidil, as a topical wash or serum cannot impair the liver's enzymatic machinery. — Dr. Dray

> [13:33](https://www.youtube.com/watch?v=EbC6oTVlkAM&t=813s) Don't forget sunscreen and subscribe. — Dr. Dray

## Mentioned Dr. Dray, Colloidal oatmeal, Avena Sativa (Oat) Extract, FDA, Tazarotene (Tazorac), Tretinoin, Isotretinoin (Accutane), Glycolic acid, Thermage, Morpheus8, Ultherapy, Sofwave, Fraxel Laser, Ellacor Micro-Coring, Salicylic acid, Minoxidil, Sulfotransferase (SULT1A1), Aspirin (Acetylsalicylic acid)

## Video description Dermatologist Dr. Dray answers more skincare questions from viewers, covering colloidal oatmeal, retinoid purging, glycolic acid, salicylic acid cleansers, minoxidil, veinous lakes, and skin tightening after weight loss.

In this skincare Q&A, Dr. Dray explains the difference between colloidal oatmeal and Avena Sativa (oat) meal extract, whether switching from tazarotene to tretinoin can cause breakouts, and what determines how strongly a 10% glycolic acid body product exfoliates.

She also discusses treatment options for mild loose or lax skin after significant weight loss, whether veinous lakes on the lips are related to sun exposure, and why salicylic acid cleansers can still exfoliate the skin even though they are rinsed off.

Several questions address the relationship between salicylic acid and minoxidil, including an important distinction between salicylic acid and aspirin. Dr. Dray also explains why "purging" is often incorrectly blamed for breakouts and irritation from skincare products.

In this video:

• Colloidal oatmeal vs. Avena Sativa oat extract • Can you use colloidal oatmeal every day? • Tazarotene vs. tretinoin and breakouts • Is retinoid purging actually a thing? • Using 10% glycolic acid on the body • What determines the strength of glycolic acid exfoliation? • Skin tightening after major weight loss • RF, ultrasound, microneedling and cosmetic skin tightening • Are veinous lakes on the lips caused by sun damage? • Do salicylic acid cleansers actually exfoliate? • Salicylic acid vs. aspirin and minoxidil • Can salicylic acid interfere with topical minoxidil? • Can salicylic acid cause purging? • Salicylic acid irritation around the eyelids and hands • Oral minoxidil and NSAIDs • When breakouts are more likely irritation than purging

Timestamps

0:00 Intro 0:04 Colloidal Oatmeal vs. Oat Extract 1:22 Tazarotene vs. Tretinoin: Is This Purging? 2:38 Is 10% Glycolic Acid Too Strong for the Body? 3:52 Skin Tightening After Major Weight Loss 6:14 Are Veinous Lakes on the Lips Caused by Sun Damage? 7:14 Do Salicylic Acid Cleansers Actually Exfoliate? 8:14 Salicylic Acid, Aspirin and Minoxidil 10:35 Can Salicylic Acid Cause Purging? 11:14 Does Salicylic Acid Interfere With Minoxidil? 13:33 Outro

Whether you're dealing with sensitive skin, acne, retinoid irritation, body exfoliation, hair loss, or changes in your skin after weight loss, Dr. Dray breaks down these common skincare questions from a dermatologist's perspective.

#Skincare #Dermatologist #DrDray #SkincareQandA #SalicylicAcid #Minoxidil #Tretinoin #Tazarotene #GlycolicAcid #ColloidalOatmeal #Acne #HairLoss #SkincareTips #skincare

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[Source](https://www.youtube.com/watch?v=EbC6oTVlkAM)

中文简报

水杨酸会导致“爆痘”吗？皮肤科医生问答临床上真正的“爆痘”现象极少发生且常被误解，外用水杨酸引起的新发皮损通常提示皮肤屏障受刺激；不过，冲洗型水杨酸洁面仍能通过迅速渗入毛囊发挥去角质效果，且外用水杨酸未被证实会削弱米诺地尔的疗效。此外，射频及超声等非侵入性紧肤疗法对减重后的轻度皮肤松弛也能带来切实改善。真正的临床“爆痘”普遍被误解且在临床上十分罕见，它几乎仅出现于口服异维A酸治疗中，而非外用维A酸类或水杨酸；对于后者，新长出的痘痘通常意味着皮肤屏障受到了刺激。 (1:22) 冲洗型水杨酸洁面产品能够有效去除角质，因为亲脂性水杨酸可以迅速渗透富含皮脂的毛囊，并通过凝聚作用留下一层具有活性的微观薄膜。 (7:14) 虽然口服阿司匹林会抑制毛囊磺基转移酶并减弱外用米诺地尔的活化，但目前尚无证据表明外用水杨酸会对米诺地尔的疗效产生不利影响，而口服米诺地尔经肝脏代谢，不受非甾体抗炎药（NSAIDs）影响。 (8:14) 射频、超声和微孔切除（micro-coring）等非侵入性紧肤疗法，能为减重后的轻度皮肤松弛带来可衡量的改善，特别是对于胶原蛋白储备尚好的年轻人群。 (3:52)

Reading summary

Dermatologist Dr. Dray clarifies clinical realities surrounding skincare ingredients, arguing that breakouts from topical exfoliants stem from barrier irritation rather than true purging, and debunking fears regarding salicylic acid's interaction with minoxidil. Topical Purging Myths vs. Barrier Irritation (1:22) Dr. Dray dispels the widespread consumer belief that topical retinoids and chemical exfoliants like salicylic acid routinely cause clinical 'purging.' While topical retinoids and salicylic acid accelerate cellular turnover, Dr. Dray explains that true clinical purging is almost exclusively observed when patients with severe nodulocystic acne initiate oral isotretinoin (Accutane), pushing deep inflammatory lesions to the surface during the first month. When patients switch between retinoids (such as from tazarotene to tretinoin 0.05%) or introduce salicylic acid and subsequently break out, the reaction is rarely a biological purge. Instead, new acne flares are overwhelmingly driven by non-specific irritation, impaired skin barrier function, or sensitivity to inactive vehicle ingredients like emulsifiers and preservatives. Regulatory and Chemical Formulation Determinants (0:00) Ingredient efficacy depends heavily on regulatory classification and chemical environment. For oat-based care, Dr. Dray contrasts over-the-counter colloidal oatmeal—regulated by the FDA to an exact particle size and legally permitted to carry therapeutic skin protectant claims—with cosmetic oat extract (Avena sativa), which cannot legally claim to treat medical conditions. Regarding chemical exfoliants, Dr. Dray notes that a percentage alone does not define potency. For instance, in 10% glycolic acid body products used for keratosis pilaris, lower pH formulations have a higher free acid value that increases keratolytic strength and irritation, whereas buffered, higher-pH formulas act more gently as humectants. Similarly, rinse-off salicylic acid cleansers remain genuinely therapeutic because lipophilic salicylic acid quickly penetrates sebum-rich follicles, and a process called coacervation leaves a micro-film of active ingredient on the skin after rinsing. Minoxidil Activation Pathways and Salicylate Interactions (8:14) Addressing concerns that salicylic acid might compromise minoxidil's effectiveness, Dr. Dray explains the enzymatic pathways involved in androgenetic alopecia treatments. Topical minoxidil is a prodrug that requires activation by the sulfotransferase enzyme (SULT1A1) in the hair follicle's outer root sheath. While systemic low-dose daily aspirin (acetylsalicylic acid) can suppress follicular sulfotransferase and blunt topical minoxidil's results, no clinical research demonstrates that topical salicylic acid impairs minoxidil. Dr. Dray observes that patients routinely combine salicylic acid dandruff shampoos with minoxidil and maintain positive hair growth outcomes. Furthermore, oral minoxidil is converted into active minoxidil sulfate in the liver via hepatic sulfotransferase, bypassing follicular enzyme levels entirely. A retrospective study confirmed that patients taking oral minoxidil alongside aspirin or NSAIDs showed no statistical difference in hair density or counts, confirming that neither systemic NSAIDs nor topical salicylic acid interfere with oral minoxidil therapy. Clinical Interventions for Tissue Laxity and Vascular Lip Lesions (3:52) Dr. Dray outlines physical and procedural interventions for structural skin issues, noting that younger patients—such as a 27-year-old with abdominal laxity following major weight loss—benefit from robust collagen reserves when undergoing non-invasive tightening. Modalities range from bulk deep-heating radiofrequency (Thermage) and micro-pin delivery (Morpheus8) to micro-focused ultrasound (Ultherapy, Sofwave), superficial resurfacing lasers (Fraxel), and energy-free mechanical micro-coring (Ellacor). Regarding vascular lesions, Dr. Dray confirms that venous lakes—dark blue or purple papules commonly found on the lower lip—primarily result from chronic cumulative UV radiation that breaks down connective tissue support around microvasculature, alongside intrinsic aging, genetics, and direct physical trauma. Dr. Dray emphasizes that while theoretical interactions and biological mechanisms often cause consumer anxiety, real-world clinical evidence demonstrates that topical salicylic acid does not impede minoxidil therapy, and unexpected breakouts reflect barrier disruption that warrants gentler use rather than waiting out a presumed purge.

Source quotes

[0:04] Dr. Dray: it is virtually impossible to rely exclusively on colloidal oatmeal unless someone plans on buying a plain box of powdered bath treatment to reconstitute in water. [1:22] Dr. Dray: true clinical purging rarely unfolds the way consumers imagine. [1:22] Dr. Dray: The new breakouts can stem from barrier impairment caused by tretinoin itself, sensitivity to inactive vehicle ingredients (emulsifiers, preservatives, or bases) in the new formulation, or external factors entirely unrelated to the retinoid change. [2:38] Dr. Dray: two distinct 10% glycolic acid products from different brands can behave in completely different ways on the skin. [3:52] Dr. Dray: a 27-year-old possesses a significantly more robust reservoir of collagen and elastin, yielding far better responses to non-invasive tightening modalities than someone over 40. [6:14] Dr. Dray: being in a bar fight. [7:14] expensive water [7:14] Dr. Dray: Because salicylic acid is oil-soluble (lipophilic), it rapidly penetrates into the sebum-rich environment of the hair follicle even during a brief lather. [9:18] Dr. Dray: there is simply no convincing clinical or objective evidence suggesting that salicylic acid is contraindicated or that the two topicals cannot work synergistically. [10:35] Dr. Dray: In the vast majority of cases where somebody experiences breakouts after introducing a new topical exfoliating product like salicylic acid, the issue is skin barrier irritation and inflammation rather than a genuine biological purge. [11:14] Dr. Dray: using topical salicylic acid poses zero threat to oral minoxidil, as a topical wash or serum cannot impair the liver's enzymatic machinery. [13:33] Dr. Dray: Don't forget sunscreen and subscribe.

Original transcript

[0:00] Hey guys, happy Saturday. Welcome back [0:02] to the Q&A. Let's get into it. I'm [0:04] getting over a major hives outbreak from [0:06] head to toe. It was due to an allergic [0:08] reaction to a new medication. I just [0:10] want to use colloidal oatmeal going [0:11] forward. Is it okay to use products with [0:13] this ingredient going forward daily? And [0:15] what's the difference between colloidal [0:17] oatmeal and Avena sativa oatmeal extract [0:21] in skin care? Yeah, that's fine to do, [0:24] but it's unlikely that you're going to [0:25] use skin care products that only have [0:27] colloidal oatmeal in them unless you're [0:29] literally going to buy a box of [0:30] colloidal oatmeal and only ever put that [0:32] on your skin. I mean, you still need [0:34] sunscreen. In other words, you're going [0:35] to get other ingredients in skin care. [0:37] You're rarely going to get just [0:39] colloidal oatmeal unless, like I said, [0:41] that's all you're using is the powdered [0:43] stuff that you reconstitute in water. [0:45] Colloidal oatmeal is [0:47] an over-the-counter medication. It is [0:49] FDA approved to make the treatment claim [0:52] that it is a skin protectant. Whereas, [0:54] oatmeal extract is a cosmetic [0:56] ingredient. So, there they, you know, [0:59] are going to be describing it as, you [1:01] know, soothing, improves the look of dry [1:03] skin. But, they can't make treatment [1:05] claims around it. Colloidal oatmeal is [1:07] actually a finely ground powder made [1:09] from grinding up the oats, basically, [1:11] and then processed in a way that it gets [1:13] it down to a certain very specified [1:15] particle size. Whereas, oatmeal extract [1:17] is like a concentrated liquid or powder [1:19] derived from certain part of the oat [1:21] plant. I used Tazorac consistently for [1:24] years, but recently switched to [1:25] tretinoin 0.05% because my skin was [1:28] staying sensitized. Now, I'm breaking [1:29] out. Is it Is purging a thing when going [1:31] from one retinoid to another? No, you [1:34] know, purging doesn't really happen like [1:36] people think it does with topical skin [1:38] care products, including, honestly, [1:39] topical retinoids. Theoretically, yes, [1:41] it's possible because they improve the [1:43] rate of skin cell turnover, but it's [1:45] genuinely not something that we actually [1:47] see clinically. Where we see it is [1:49] pretty much only when patients with [1:51] acne, usually nodulocystic acne, start [1:54] oral isotretinoin. The acne typically [1:57] becomes a lot more severe in the first [1:59] month as that acne below the surface of [2:01] the skin is coming to the surface. It is [2:03] unlikely though that someone who has [2:06] acne and is, you know, either well I [2:09] don't I don't know how well controlled [2:10] your acne was, but it's unlikely that [2:13] it's brought more acne out to the [2:15] surface per se just by switching to a [2:17] different retinoid. What's more likely [2:19] is irritation. That could either be [2:20] related to the change to tretinoin or to [2:23] tazarotene is usually more irritating [2:25] than tretinoin, but that varies from [2:27] person to person. It could be due to [2:28] changes in from one vehicle to another, [2:31] some inactive ingredient, or it could [2:33] have nothing to do with this. It could [2:35] have something to do with something [2:36] else. Hard to say what's exactly going [2:38] on though. Would it be good to use 10% [2:40] glycolic acid spray as a body exfoliant [2:44] or is it too much for body skin? Too [2:46] much really varies depending on the [2:48] person and the product because you're [2:50] going to find a lot of variation out [2:53] there as far as what people tolerate on [2:55] their skin. 10% glycolic acid could be [2:57] very good for moisturizing the skin, [2:59] reducing bumpiness, smoothing [3:02] out the skin surface, and helping to [3:04] hasten the clearance of unwanted [3:05] hyperpigmentation. Like I frequently [3:07] recommend many 10% glycolic acid body [3:09] lotions for like keratosis pilaris, for [3:12] example. However, uh glycolic acid in [3:15] skin care products, its performance, how [3:18] it goes for an individual, also is very [3:21] much influenced by the overall [3:23] formulation because glycolic acid is [3:25] more so impacted by like the pH which [3:28] can affect the free acid value and that [3:31] with glycolic acid does end up having [3:33] some meaningful effects. In other words, [3:34] a 10% glycolic acid product from one [3:37] brand is not going to necessarily [3:39] perform the same as a 10% glycolic acid [3:42] product from another one. But long story [3:44] short, it can be great for hydration, [3:46] smoothing the skin surface, and many [3:47] people tolerate it well. I just can't [3:49] predict any of those things for any [3:51] given person. I have lost near 100 [3:54] pounds from GLP-1 medication. I don't [3:56] have super loose skin, but it does not [3:58] look tight. Which lasers would be the [3:59] best or other treatments that I could [4:02] get for mild abdominal help in the mid [4:05] abdomen. I am 27. So, only the provider [4:08] who is, you know, you're consulting with [4:11] can actually recommend what is going to [4:14] be best for you after they've evaluated [4:16] you. Like, I can't just blindly say, [4:17] "Oh, this is the best treatment for X, [4:20] Y, and Z." But, generally speaking, [4:22] first of all, because you are What did [4:24] you say? 27? It's likely that you are [4:27] going to have sort of a more robust, [4:29] we'll say, reservoir and response to [4:32] non-invasive, non-surgical skin [4:35] tightening procedures due to the quality [4:37] of collagen and elastin in the skin [4:39] versus, like, you know, a 40-plus year [4:41] old, for example. Now, there are a [4:43] variety of non-invasive, energy-based [4:45] devices that can really help with mild [4:48] laxity, skin tightening, generally in [4:50] the category of radio frequency and/or [4:52] ultrasound. Thermage, for example, is a [4:54] commonly pursued a monopolar radio [4:57] frequency device that heats the deeper [4:59] parts of the skin to stimulate collagen [5:02] production having a tightening effect. [5:04] Morpheus 8 also is radio frequency, but [5:07] it combines it with microneedling for a [5:09] little bit deeper as far as the [5:11] targeting. And so, you can get somewhat [5:13] better tightening for maybe a little bit [5:15] more prominent laxity there. Again, this [5:17] will all be determined by who evalue you [5:19] know, the the person's opinion after [5:21] evaluating you. There's also [5:23] Ultherapy, which is ultrasound or [5:26] softwave. These treatments use focused [5:28] ultrasound rather than radio frequency. [5:30] These target the deeper tissues and have [5:33] sort of a lifting, smoothing effect over [5:35] time. Now, a resurfacing laser, like [5:37] Fraxel, for example, that can help with, [5:39] like, subtle surface laxity, crapiness [5:43] mostly by improving collagen production [5:46] in the upper parts of the dermis. But, [5:48] that's going to be more focused on [5:50] overall skin quality. Then there's [5:52] micro-coring, goes by the name Ellacor. [5:54] This is kind of cool. It doesn't [5:55] actually use an energy, but rather it [5:58] takes out little tiny microscopic [6:00] columns out of out of your skin. And in [6:02] doing so, you get this kind of wound [6:05] healing response with within those [6:06] columns that results in a tightening [6:08] effect as well. And that can help reduce [6:10] mild sagging and has much, you know, it [6:13] has a pretty minimal downtime. Venus [6:15] lakes on the lips caused by sun damage? [6:17] Yes. So, prolonged sun exposure can [6:19] weaken the supporting structures around [6:22] the vasculature in the skin, including [6:24] the lips. And that can over time result [6:26] in more prominent dilation of blood [6:28] vessels. And on the lower lip, the [6:30] appearance of what's called a Venus [6:32] lake. Essentially, the vessel wall has [6:34] really lost its strength and its [6:35] elasticity due to cumulative UV damage. [6:38] The lower lip in particular is very [6:40] vulnerable to this because just the [6:42] location and the way that it protrudes. [6:44] It actually gets quite a bit of UV [6:45] exposure throughout your lifetime. Now, [6:47] a lot of this is also going to be [6:48] influenced by, of course, age-related [6:51] changes outside of the sun protection [6:53] aspect of things, genetics to a certain [6:55] extent. And if you have a history of [6:58] recent trauma to that to the lower lip, [7:00] for example, like biting or I don't [7:02] know, [clears throat] maybe you were in [7:03] a bar fight or something like that. [7:04] Maybe you had had something that went on [7:06] or maybe had surgery there and that it's [7:08] been known to to be triggered after [7:10] those kinds of things. But, yeah, sun [7:12] sun damage is a big kind of contributing [7:14] factor. Salicylic acid cleanser, does it [7:16] actually exfoliate if you wash it off [7:18] immediately? I feel like it's just [7:19] expensive water unless you leave it on. [7:21] No, it can still exfoliate. So, with a [7:25] very short contact time, especially with [7:26] salicylic acid, it tends to penetrate [7:28] the follicle pretty quickly, the pores. [7:30] And salicylic acid will be left behind [7:33] on the skin in a cleanser through [7:35] something known as coacervation. It's [7:37] very possible active ingredients are not [7:39] just going down the drain. Now, the [7:40] advantage of using it in a cleanser [7:42] versus a leave-on form is that you're [7:44] not going to have the [7:46] the deposition to the same extent, so it [7:48] tends to be less irritating. It's kind [7:49] of almost like a lower dose, a short [7:51] contact therapy approach. It does still [7:53] work. It's more likely to take longer to [7:56] work, to start seeing change, but it can [7:58] meaningfully improve like comedones, for [8:00] example. And it also can improve the [8:03] clearance rate, I will say, modestly [8:06] surface hyperpigmentation as well as [8:09] warts. Help them go away a little bit [8:11] faster, but it's going to take longer to [8:13] work than a leave-on form would. Just [8:15] learned how it uses a sulfotransferase [8:18] pathway and potentially blocks minoxidil [8:20] on the scalp. Was trying to see what was [8:22] going on there because it does feel [8:24] great on my face. I think it's too harsh [8:25] though. I think this person is talking [8:27] about salicylic acid cleanser. And maybe [8:29] they're they've heard about the aspirin [8:30] thing. So, I want to talk about this cuz [8:32] it's interesting. So, aspirin, if you [8:33] weren't aware, if you're using a topical [8:35] minoxidil for androgenetic alopecia, it [8:38] is a prodrug. And so, you have an enzyme [8:41] in the hair follicle called sulfo- [8:43] sulfotransferase that has to work on the [8:46] minoxidil in order to get minoxidil to [8:48] its active form, so that the minoxidil [8:50] can work to grow your hair. Well, some [8:52] people don't appear to have very good [8:54] levels of sulfotransferase [8:56] or just doesn't work particularly well [8:59] for whatever reason, and that's not to [9:01] underscore why some people simply do not [9:03] respond to topical minoxidil. But, it's [9:05] also been suggested in some research [9:08] studies that taking low-dose daily [9:10] aspirin can lower the sulfotransferase [9:13] level in the follicle and make minoxidil [9:16] not as effective, topical minoxidil not [9:18] as effective. Now, salicylic acid is [9:20] very similar to [9:23] aspirin as far as metabolites of [9:26] aspirin. And it's thought that perhaps, [9:29] theoretically, salicylic acid could have [9:31] the same effect. But, that being said, I [9:33] have never seen any any research [9:36] actually looking at can common [9:38] application of topical salicylic acid [9:41] alongside topical minoxidil and the [9:43] overall efficacy of topical minoxidil [9:45] for androgenetic alopecia. And prior to [9:48] this being brought to light over the [9:51] past several years with regards to [9:53] low-dose daily aspirin's impacts on [9:55] topical minoxidil. I I mean no one ever [9:58] brought up salicylic acid alongside [10:00] minoxidil and so I've never seen any [10:02] convincing evidence that you can't use [10:04] the two topicals together. Um [10:06] theoretically I suppose it's possible [10:08] but I have seen many patients who use [10:10] salicylic acid dandruff shampoos and [10:13] still get good results from minoxidil. [10:15] I'm not convinced that the salicylic [10:17] acid is necessarily contraindicated. [10:20] I've never really seen any objective [10:22] evidence with that regard but I mean you [10:25] know it's fine to not use them together [10:27] if you're worried but I haven't seen [10:29] convincing evidence to tell people and [10:31] never use salicylic acid with minoxidil. [10:34] They cannot work together topically. I [10:36] was wondering if there's a purging stage [10:38] with salicylic acid products. So [10:40] salicylic acid does exfoliate the skin [10:43] and so it increases the rate of cellular [10:45] turnover and therefore there's always [10:46] this concern that it's going to bring [10:48] out more acne. We don't see that with [10:50] topicals. We really only see it with [10:52] oral isotretinoin in patients with [10:54] nodular cystic acne. They can experience [10:56] a worsening of acne usually in the first [10:58] month. Sometimes that worsening can be [11:00] quite bad but I think people way over [11:03] estimate the degree of and the reality [11:06] of purging. More often than not people [11:08] develop irritation from skin care [11:10] products not true purging quote unquote. [11:13] Does salicylic acid interfere with [11:15] minoxidil efficacy topical or oral? [11:18] Again, um this this time though I want [11:21] to answer this question a little bit [11:23] differently cuz um here we have some [11:25] different information. So as far as [11:28] minoxidil oral aspirin low-dose oral [11:31] aspirin appears to reduce the efficacy [11:33] of topical minoxidil. Um we don't know [11:36] about topical minoxidil and topical [11:38] salicylic acid. But as far as oral [11:41] minoxidil for androgenetic alopecia, cuz [11:43] a lot of people end up using oral [11:45] minoxidil, it's very effective. While it [11:47] does require the sulfotransferase, it [11:49] doesn't need it to be in the follicle. [11:52] The sulfotransferase activity when you [11:54] take minoxidil orally, it's working in [11:57] your liver, okay? That's where that [11:59] happens, not in the level of follicle. [12:00] It gets activated in your liver first [12:02] before it ever makes it to the follicle. [12:04] So, whatever the follicle [12:05] sulfotransferase is in your scalp, [12:08] doesn't matter, okay? So, it'll bind it [12:10] that's not a non-issue. And there is a [12:12] retrospective study that actually looked [12:15] I mean, that's not a perfect way to [12:16] assess this, okay? So, there are [12:17] limitations. But there is a [12:19] retrospective study that looked at [12:20] patients who were using minoxidil and [12:24] had their hair counts and density, I [12:26] believe it was, measured. And those [12:29] taking aspirin and other medications of [12:32] concern for this possible effect didn't [12:35] show any differences in like the hair [12:37] count or anything. In other words, they [12:38] still appeared to be responding equally [12:41] as well to oral minoxidil despite these [12:44] medications, which seemed to negatively [12:46] impact the efficacy of topical minoxidil [12:49] due to perhaps a reduction in [12:51] sulfotransferase activity at the level [12:54] of the follicle. But with oral [12:55] minoxidil, you're going through the [12:57] liver, and so perhaps it's not a thing. [12:59] It doesn't seem like it's an issue. So, [13:02] in other words, patients who need to [13:03] take medications in this class, you [13:05] don't have to tell them, "Oh, you can't [13:07] use oral minoxidil for hair, it won't [13:09] work." Seems like it can, and so we're [13:11] not telling people to stop the systemic [13:14] NSAIDs. But again, we don't really have [13:16] data on topical salicylic acid for any [13:18] of this, but topical salicylic acid [13:21] definitely shouldn't make a difference [13:22] at all for oral minoxidil, cuz again, [13:25] topical salicylic acid is not going to [13:27] impact your liver's ability to activate [13:29] minoxidil, okay? So, that is very, very, [13:33] very unlikely. All right, guys. Thank [13:35] you so much for watching today's video. [13:37] If you enjoyed it, give it a thumbs up, [13:38] share it with your friends, and as [13:39] always, don't forget sunscreen and [13:41] subscribe. I'll talk to you guys [13:42] tomorrow. Bye. [13:44] >> [music] [14:00] [music]