Theoretical and potential combined use of salicylic acid, azelaic acid, and lactic acid in acne care

Acne vulgaris is a multifactorial inflammatory skin disorder driven by abnormal keratinization, microbial proliferation, excessive sebum production, and immune-mediated inflammation. Acidic compounds such as salicylic acid (SA), azelaic acid (AZA), and lactic acid (LA) have gained attention for their keratolytic, antimicrobial, and anti-inflammatory effects. However, monotherapies face limitations such as poor penetration, irritation, and limited efficacy. A combined approach using SA, AZA, and LA may enhance therapeutic outcomes by leveraging their complementary actions: SA’s follicular penetration and comedolytic effect, AZA’s antimicrobial and anti-inflammatory properties, and LA’s keratin modulation and hydration benefits. This review examines their synergistic potential, mechanisms, and clinical relevance, highlighting the need for optimized formulations and clinical validation to improve acne management.