If you have searched this before, you will have found everything from avoid completely to it is perfectly fine. Both answers skip the part that matters, which is how much of it your skin takes in and what pregnancy does to that number.
This article walks through the evidence and explains why nātelle leaves salicylic acid out, as part of The Pregnancy Skincare Guide. If breakouts brought you here, read it alongside pimples in early pregnancy.
Should you use salicylic acid during pregnancy?
Our position is to skip it. Not because salicylic acid has been shown to cause harm, but because no one has established a safe dose in pregnancy and there is nothing you give up by choosing something else.
MotherSafe, the NSW Health medications in pregnancy and breastfeeding service, lists salicylic acid among the acne ingredients considered safe to use in pregnancy.¹ The 2024 dermatology safety review in the Journal of the American Academy of Dermatology permits topical use where the treated area and the length of treatment are limited.²
Both attach conditions. And MotherSafe adds a principle that gets quoted far less often than it should: skincare is discretionary rather than medically necessary, so where safety is uncertain, it is reasonable to ask whether you need the product at all.¹
Applied to salicylic acid, that question answers itself.
Why nātelle leaves salicylic acid out
How much salicylic acid does your skin actually absorb?
Around 60% of what you apply to intact skin is absorbed.³
That figure surprises most people, because topical tends to sound like it stays on the surface. It does not. Salicylic acid crosses the skin readily, which is precisely why it works.
At low to moderate strengths on healthy, intact skin, the systemic effects of that absorption are minimal.³ This is the basis for the reassuring advice you find elsewhere, and on intact skin it is fair.
The picture changes when the barrier is not intact. Where the outer layer has been stripped or damaged, absorption of salicylic acid has been measured at up to 150 times higher than through healthy skin.³
Salicylate toxicity from topical use has been documented and in every reported case the product was applied across a large area of the body, usually at high strength and usually onto skin already broken by a condition such as psoriasis.³
Does pregnancy change how much salicylic acid you absorb?
Almost certainly yes.
Pregnancy measurably weakens the skin barrier. In a longitudinal study, water loss through the skin rose at every single visit across pregnancy and peaked around two months after birth.⁴ Rising water loss is the standard marker of a barrier that is no longer holding together as well.
Put the two findings side by side. Compromised barrier function is the one condition known to increase how much salicylic acid gets through. Pregnancy reliably produces some degree of compromised barrier function.
Nobody has measured what that combination means in practice, because the study has not been done. So this is not a claim that pregnant women absorb a dangerous amount. It is a specific, mechanistic reason to think the reassuring absorption figures were measured in skin that behaves differently to yours.
Has topical salicylic acid been tested in pregnant women?
No. There is no trial of topical salicylic acid in pregnancy, and current guidance is extrapolated from absorption data and clinical experience rather than pregnancy evidence.²
The study most often cited in its favour applied 27 mg to the face daily for 15 days and found the amount reaching the bloodstream at least five times lower than a single 81 mg aspirin tablet.⁵ That is genuinely reassuring, and worth knowing.
It also has limits worth naming. The participants were not pregnant, the study was run by the manufacturer, and it tested one product on the face rather than the layered routines people actually use.⁵
The authors of the topical toxicity review reached the plainest conclusion of all. Formal studies are still needed to establish the maximum safe topical dose, particularly for people whose skin barrier is impaired.³
That is the honest state of the evidence. Not alarming, but not settled either.
What to use instead of salicylic acid in pregnancy
Mandelic acid, gluconolactone and niacinamide do the same work, and none of them carry the same open question.
Mandelic acid is an alpha hydroxy acid with a larger molecule than glycolic acid, so it moves into skin more slowly and more evenly. In a systematic review of acne peel trials, a combined salicylic and mandelic acid treatment outperformed glycolic acid on total acne scores.⁶
Niacinamide has direct evidence in acne. In a double-blind trial, 4% niacinamide gel performed comparably to 1% clindamycin gel, a topical antibiotic, in moderate inflammatory acne.⁷
Gluconolactone is a polyhydroxy acid. In a small split-face study it reduced water loss through the skin and had a regulating effect on oil production, although at peel strength rather than the gentler levels used in a cleanser.⁸
This is why the gentle cleanser for pregnancy in the nātelle range is built on gluconolactone and mandelic acid. Pair it with niacinamide during pregnancy and a light moisturiser during pregnancy.
What if you have already been using salicylic acid?
There is no reason to worry about the products you have used so far.
Every documented case of salicylate toxicity from topical use involved application across a large area of the body, at strengths well above cosmetic levels, on skin that was already broken.³ A face wash or a spot treatment is not that scenario, and the guidance from both MotherSafe and dermatology bodies is that limited facial use is permitted.¹˒²
So there is nothing to correct retrospectively. Simply swap it out at your next repurchase and move on.
If you are using a salicylic acid body wash, or treating your back and chest daily, that is the one situation worth raising with your doctor, midwife or MotherSafe directly, because surface area is what changes the calculation.³
While you are reviewing your shelf, the skincare ingredients to avoid during pregnancy list covers the rest.
References
- MotherSafe, Royal Hospital for Women, NSW Health. Skin care, hair care and cosmetic treatments in pregnancy and breastfeeding. Updated April 2021.
- McMullan P, Yaghi M, Truong TM, et al. Safety of dermatologic medications in pregnancy and lactation: an update - Part I: pregnancy. J Am Acad Dermatol. 2024 Oct;91(4):619-648. doi:10.1016/j.jaad.2023.10.072.
- Madan RK, Levitt J. A review of toxicity from topical salicylic acid preparations. J Am Acad Dermatol. 2014 Apr;70(4):788-92. doi:10.1016/j.jaad.2013.12.005.
- Gallagher A, Hourihane JO, Kenny LC, et al. A longitudinal study of skin barrier function in pregnancy and the postnatal period. Obstet Med. 2014 Dec;7(4):156-9. doi:10.1177/1753495X14547428.
- Davis DA, Kraus AL, Thompson GA, et al. Percutaneous absorption of salicylic acid after repeated (14-day) in vivo administration to normal, acnegenic or aged human skin. J Pharm Sci. 1997 Aug;86(8):896-9. doi:10.1021/js960496b.
- Chen X, Wang S, Yang M, et al. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi:10.1136/bmjopen-2017-019607.
- Shalita AR, Smith JG, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995 Jun;34(6):434-7. doi:10.1111/j.1365-4362.1995.tb04449.x.
- Jarzabek-Perz S, Dziedzic M, Rotsztejn H, et al. Evaluation of the effects of 10% and 30% gluconolactone chemical peel on sebum, pH, and TEWL. J Cosmet Dermatol. 2023;22:3305-3312. doi:10.1111/jocd.15864.
This article is intended as general educational information and does not constitute medical advice. Always consult your healthcare provider or dermatologist before making changes to your skincare routine during pregnancy.
