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In a previous article, we provided a detailed introduction to the treatment of melasma, often referred to as the ‘king of blemishes’, using meso needle mesotherapy. Those interested can click to view it. Today, in this article , we will discuss another skin condition that has received a lot of attention in recent years — Rosacea.

Part 01. Rosacea and salicylic acid

Rosacea is not just ordinary pimple; it’s a chronic skin condition that primarily affects the centre of the face. Symptoms include facial redness, erythema, papules, pustules and visible red blood vessels on the skin’s surface. Although it primarily affects women, male patients generally experience more severe symptoms. Common clinical treatments include oral and topical medications, physical therapy and, in severe cases, surgery. In addition to the above treatments, salicylic acid chemical peels have become an increasingly popular way of treating rosacea in the past two years.

So, what is salicylic acid? Salicylic acid is found in many plants. It inhibits the synthesis of inflammatory mediators, such as prostaglandins, making it a potent anti-inflammatory agent. Its lipid solubility allows it to easily penetrate sebum-rich hair follicles. It can dissolve cellular debris and excess sebum that clogs pores, acting as a ‘cleanser’. At the same time, it gently exfoliates the stratum corneum, promoting normal skin cell turnover. Thanks to these properties, salicylic acid is highly effective in treating skin conditions such as acne, dandruff and psoriasis.

Some people may feel afraid when they hear the word ‘acid’, but salicylic acid peels with a concentration of 20%-30% are generally considered relatively safe when carried out by a professional. Salicylic acid crystallises on the skin’s surface, forming a ‘pseudofrost’, which limits further penetration to some extent. This acts as a neutraliser, reducing the risk of excessive peeling and chemical burns. Studies comparing salicylic acid peels with other peeling agents have found that adverse reactions such as erythema and stinging caused by salicylic acid tend to be milder and shorter-lived.

This article reviews the literature and analyses the mechanism of action of salicylic acid and the pathogenesis of rosacea, in order to clarify whether salicylic acid peels can treat rosacea.

Part 02. Literature interpretation

(1) As early as 2004, foreign scholars conducted research into treating rosacea with salicylic acid chemical peels. The paper was published in JAAD (the Journal of the American Academy of Dermatology), a leading academic journal in the field of dermatology.
The study examined the effectiveness of 25% salicylic acid peels in treating papulopustular rosacea. The peels were applied three to four times at three- to four-week intervals.
The results showed that the papules and pustules subsided rapidly after treatment and that erythema also improved. The researchers hypothesised that salicylic acid might stimulate fibroblasts and improve vasodilation in rosacea.

(2) In 2022, Chinese doctors published the first paper on using supramolecular salicylic acid peels to treat rosacea.
The study involved three peels, each three weeks apart. Nine weeks later, transepidermal water loss, skin hydration and erythema index were assessed.
The results showed that supramolecular salicylic acid peeling significantly improved the erythema index and the overall appearance of the skin in patients with rosacea. The treatment demonstrated good therapeutic efficacy, tolerability and safety.

The literature also mentions adverse reactions that occurred during the trial. Although all patients tolerated the procedure well, minor discomfort such as burning and stinging was reported, which are common reactions to chemical peels. Twelve patients developed facial erythema at the end of the procedure, which cleared up the next day. Six patients experienced mild desquamation and crusting, which cleared within four to six days.

(3) In 2025, Professor Jiang Xian and his team at West China Hospital published a paper providing strong evidence of the effectiveness of supramolecular salicylic acid peeling in the treatment of rosacea.
The study included 480 patients aged 18–60 years with papulopustular rosacea. Participants were randomly assigned at a ratio of 1:1 to receive either 30% supramolecular salicylic acid or a placebo every two weeks for six weeks, with follow-up assessments continuing until week eight.
The results showed that, by week 8, the primary efficacy endpoint (the severity of erythema, papules and pustules) had significantly improved in the salicylic acid group, with an efficacy rate of 51.3–59.9%, compared to 18.3–20.5% in the placebo group. Significant improvements were also observed in pore size, fine lines and oiliness.
These results emphasise that 30% supramolecular salicylic acid is superior to placebo in improving the symptoms of papulopustular rosacea and is well tolerated. Regarding adverse reactions, eight patients in the salicylic acid group experienced a single adverse event, six of which were considered to be related to the study drug.

(4)In 2025, Chinese doctors published a paper on treating rosacea with 30% supramolecular salicylic acid. In addition to observing improvements in papules and pustules, the paper assessed the impact on the skin barrier.
Thirty-four patients were randomly assigned to the experimental or control group. The experimental group received 30% supramolecular salicylic acid treatment every two weeks, for a total of four treatments. The control group received a placebo containing a carrier matrix of supramolecular salicylic acid, but without the active salicylic acid component.

All participants were invited to take part in a skin barrier test indoors. They were instructed not to wash their face with water for three hours beforehand and to rest indoors for 20 minutes prior to the test. Transepidermal water loss, stratum corneum hydration, sebum production and pH were then measured in sequence. Measurement sites included the cheeks, nose and foreheads.
At the end of the experiment: In the experimental group, one case achieved complete remission, ten cases showed significant improvement and five cases showed improvement. There were no ineffective cases, giving an effective rate of 68.75%.
In the control group, there was no significant improvement, giving an effectiveness rate of 0%.
Regarding adverse reactions, all 15 subjects in the experimental group reported negligible burning sensations and one subject reported a mild stinging sensation.

The results of the study showed that patients had significantly lower sebum levels, particularly on their cheeks and foreheads, and improved stratum corneum hydration.

Part 03. Analysis and Summary

1. Based on published medical literature and the properties of salicylic acid itself, it has been proven that 30% supramolecular salicylic acid is safe and effective in treating papulopustular rosacea.

2. The recommended interval between 30% supramolecular salicylic acid chemical peels for rosacea is 3–4 weeks. Significant results can be achieved after three treatments. When using these peels to treat papulopustular rosacea, it is recommended that water is added to enhance penetration, with the salicylic acid concentration gradually increased to 30%. Treatment time is determined by the appearance of uniform erythema. If large patches of white powder appear, there is no need to worry; simply wash them off with water. This will not exacerbate the skin reaction.

3. As salicylic acid can be irritating, caution should be exercised when applying it to rosacea with erythematous telangiectasia. However, the advantage of supramolecular salicylic acid is that it is relatively gentler than traditional liquid salicylic acid, with an initial concentration of 5–8% when applied to the face. Furthermore, it is not recommended to add water to enhance absorption when using acid peels. After applying the gel, gently massage it in without adding water. The application time should be determined based on the endpoint reaction to maximise the anti-inflammatory effects.

4. The effects of salicylic acid on the skin barrier are still a matter of debate. Although papers by Chinese experts suggest that 30% supramolecular salicylic acid improves the skin barrier in papulopustular rosacea, this result cannot be extrapolated to other types of rosacea. Further basic and clinical research into salicylic acid chemical peels is expected.