Absorption of topical salicylates via the skin....an issue post RNY?
I've been researching this on pubmed and other medical journal databases that I have access to via work and I have not been able to find an answer to this question, so I'm turning to my panel of "experts" to see what you all think. Is Aspirin absorption via the skin an issue post RNY? Will the skin absorb enough aspirin topically to cause an increase risk of ulcers?
Here's why I ask...
Last week I had a bear of a workout with the trainer 4 days in a row and I literally could not move my muscles were so sore. My boyfriend rubbed me down with what I thought was just a plain ole massage cream until I looked at the tube and it was aspercreme...which contains Trolamine Salicylate which is a topical salicylate pain and inflammation reducer. I know that Aspirin is also in the salicylate family which immediately put me on red alert...I jumped up and hopped in the shower to wa**** off.
Since then, I've been researching this to no avail and I can't seem to get a clear answer on what the risk is for these products for causing ulcers in post opts. During my research, I discovered that most topical muscle rubs (bengay, and sportscreme) contain this same active ingredient. Most of the literature seems to be geared towards athletes and it suggests that absorption through the skin is minimal for the active ingredients which makes them mostly ineffective. That's great to know that it won't do squat for my sore muscles, but I'm wonder exactly how much IS absorbed via the skin and if that amount is enough to cause an issue.
I'm also asking this question because as summer approaches, my skin is getting congested from all the sweat and sebum and I'm getting more and more blackheads. My at home treatment of choice in the past was always aspirin masks (6 crushed aspirin, warm water, honey, mix to a paste, apply and let sit for 15-20 mins). This was cheap and effective and getting rid of blackheads, whiteheads, and any hormonal breakouts. I haven't done one since surgery and I'm trying to decide if I want to risk doing one to keep my skin clear this summer. Most OTC acne treatments, cleansers, masks are ineffective for me because my issue isn't really pimples, its clogged pores and outside of expensive and irritating acid peels, nothing else works (the aspirin mask is a mild acid peel because of the salicylates).
So....thoughts? Comments? What say the experts?
Here's why I ask...
Last week I had a bear of a workout with the trainer 4 days in a row and I literally could not move my muscles were so sore. My boyfriend rubbed me down with what I thought was just a plain ole massage cream until I looked at the tube and it was aspercreme...which contains Trolamine Salicylate which is a topical salicylate pain and inflammation reducer. I know that Aspirin is also in the salicylate family which immediately put me on red alert...I jumped up and hopped in the shower to wa**** off.
Since then, I've been researching this to no avail and I can't seem to get a clear answer on what the risk is for these products for causing ulcers in post opts. During my research, I discovered that most topical muscle rubs (bengay, and sportscreme) contain this same active ingredient. Most of the literature seems to be geared towards athletes and it suggests that absorption through the skin is minimal for the active ingredients which makes them mostly ineffective. That's great to know that it won't do squat for my sore muscles, but I'm wonder exactly how much IS absorbed via the skin and if that amount is enough to cause an issue.
I'm also asking this question because as summer approaches, my skin is getting congested from all the sweat and sebum and I'm getting more and more blackheads. My at home treatment of choice in the past was always aspirin masks (6 crushed aspirin, warm water, honey, mix to a paste, apply and let sit for 15-20 mins). This was cheap and effective and getting rid of blackheads, whiteheads, and any hormonal breakouts. I haven't done one since surgery and I'm trying to decide if I want to risk doing one to keep my skin clear this summer. Most OTC acne treatments, cleansers, masks are ineffective for me because my issue isn't really pimples, its clogged pores and outside of expensive and irritating acid peels, nothing else works (the aspirin mask is a mild acid peel because of the salicylates).
So....thoughts? Comments? What say the experts?
HW & SW: 363 Surgery date: 8/22/11 
What a great question. Brenda (aka Seattle_Maui) had a blog entry a couple of weeks ago about using Voltaren gel as an analgesic. Voltaren is an NSAID.
Now here's where it gets tricky I think: Her surgeon (if I remember correctly) does not see her use of Voltaren gel as a problem. My opinion is that anything we use topically will absorbed through our skin. I don't know how much it would take to cause an problem though, and I think the medical community at large is still debating this.
As far as your use of aspirin as a mask, I have heard of that as well. What you could try as an alternate treatment until you decide if the possible salicylate absorbtion is worth the risk is a yogurt mask. Lactic acid has been used as a skin smoother for thousands of years.
I would probably mix it up with the following: plain yogurt, honey, a dab of oatmeal for exfoliation, and maybe a hint of tea tree oil, which is an antibacterial and antifungal, as you may know.
Now here's where it gets tricky I think: Her surgeon (if I remember correctly) does not see her use of Voltaren gel as a problem. My opinion is that anything we use topically will absorbed through our skin. I don't know how much it would take to cause an problem though, and I think the medical community at large is still debating this.
As far as your use of aspirin as a mask, I have heard of that as well. What you could try as an alternate treatment until you decide if the possible salicylate absorbtion is worth the risk is a yogurt mask. Lactic acid has been used as a skin smoother for thousands of years.
I would probably mix it up with the following: plain yogurt, honey, a dab of oatmeal for exfoliation, and maybe a hint of tea tree oil, which is an antibacterial and antifungal, as you may know.
Thanks for the suggestion of Lactic Acid. I have SUPER oily skin and lactic acid just isn't strong enough to power through the oil to unclog the pores unless I use a higher strength (like say 40%).
So I thought about just buying a 15% Salicylic Acid Peel from Makeup Artist's Choice...until I saw the following warning:
"Cautions:
Because salicylic acid is in the aspirin-family, it's important for clients who are allergic to aspirin to avoid salicylic acid usage. "
*SIGH*
So now I'm wondering is this warning applies to things like 2% salicylic acid found in creams, lotions or even in face washes (which would be like 90% of the skin care products I own). From what I know, Salicylic acid only penatrates the dermis layer of the skin (when used as a peeling agent)....but obviously there is some absorption via the skin into the blood stream otherwise why issue the warning?
I guess the bigger concern besides my oily skin issues, is that salicylates are found in TONS of OTC products and I'm wondering how people avoid them (or if they avoid them). Heck I didn't even know it was in Pepto Bismol until someone asked that question the other day...its also in immodium and a ton of other products but its not listed in the active ingredients as being Aspirin or even in the aspirin family and most of these products carry no aspirin warning.
So I thought about just buying a 15% Salicylic Acid Peel from Makeup Artist's Choice...until I saw the following warning:
"Cautions:
Because salicylic acid is in the aspirin-family, it's important for clients who are allergic to aspirin to avoid salicylic acid usage. "
*SIGH*
So now I'm wondering is this warning applies to things like 2% salicylic acid found in creams, lotions or even in face washes (which would be like 90% of the skin care products I own). From what I know, Salicylic acid only penatrates the dermis layer of the skin (when used as a peeling agent)....but obviously there is some absorption via the skin into the blood stream otherwise why issue the warning?
I guess the bigger concern besides my oily skin issues, is that salicylates are found in TONS of OTC products and I'm wondering how people avoid them (or if they avoid them). Heck I didn't even know it was in Pepto Bismol until someone asked that question the other day...its also in immodium and a ton of other products but its not listed in the active ingredients as being Aspirin or even in the aspirin family and most of these products carry no aspirin warning.
HW & SW: 363 Surgery date: 8/22/11
I think the answer is, we don't really know.
NSAID creams or gels that are meant to relieve pain and inflammation should probably be avoided, because those must be absorbed into the blood stream or else they would not be relieving the inflammation.
As far as salicylate in lotion or other skin care products, I'm guessing in most cases those would be small enough amounts that they would only be affecting the skin, not entering the blood stream. But I'm guessing, I don't know that for sure.
Those products would still warn patients that are allergic to aspirin to avoid them, because allergies are a different issues. RNY patients aren't advised to avoid NSAIDS because we're allergic to it. If someone is allergic to it, their immune system sees it as a threat and reacts in a way designed to protect the body from the perceived threat. Except there is no real threat and the reaction is way over the top. But RNY patients are concerned about the risk of ulcers, not allergic reactions (unless you were allergic before RNY).
I have no idea if an aspirin face mask would cause enough NSAIDS to be absorbed into the blood stream or not. And I don't know who you might ask. You could ask your surgeon, but I suspect if you asked ten surgeons, you might get several different answers. You could also ask your pharmacist and/or contact a company that makes aspirin and see if you can get any info that way.
NSAID creams or gels that are meant to relieve pain and inflammation should probably be avoided, because those must be absorbed into the blood stream or else they would not be relieving the inflammation.
As far as salicylate in lotion or other skin care products, I'm guessing in most cases those would be small enough amounts that they would only be affecting the skin, not entering the blood stream. But I'm guessing, I don't know that for sure.
Those products would still warn patients that are allergic to aspirin to avoid them, because allergies are a different issues. RNY patients aren't advised to avoid NSAIDS because we're allergic to it. If someone is allergic to it, their immune system sees it as a threat and reacts in a way designed to protect the body from the perceived threat. Except there is no real threat and the reaction is way over the top. But RNY patients are concerned about the risk of ulcers, not allergic reactions (unless you were allergic before RNY).
I have no idea if an aspirin face mask would cause enough NSAIDS to be absorbed into the blood stream or not. And I don't know who you might ask. You could ask your surgeon, but I suspect if you asked ten surgeons, you might get several different answers. You could also ask your pharmacist and/or contact a company that makes aspirin and see if you can get any info that way.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Maybe I'm not articulating myself well (happens from time to time)
I know WHY RNY folks are advised to avoid NSAIDS and aspirin, but I look for the aspirin warnings on products where its not clear that they contain aspirin (like the ****tail OTC meds Excedrin, Midol and a few others). For instance, if I had not recognized that the active ingredient in the aspercreme was in the same family as aspirin, I would still be slathering down in the stuff for post workout muscle soreness. That one light bulb moment got to me wondering why some products that belong to the same family as aspirin (such as the topical SA peel I mentioned) carry the warnings and others don't. That got me thinking about all the topical SA products that I use and if the absorption via the skin is enough to cause an increase ulcer formation risk. I mean SA is in just about every anti-aging, acne, hyperpigmention, wrinkle, fine-line skin product on the market so I'm wondering if these products will cause RNY patients any harm.
I know WHY RNY folks are advised to avoid NSAIDS and aspirin, but I look for the aspirin warnings on products where its not clear that they contain aspirin (like the ****tail OTC meds Excedrin, Midol and a few others). For instance, if I had not recognized that the active ingredient in the aspercreme was in the same family as aspirin, I would still be slathering down in the stuff for post workout muscle soreness. That one light bulb moment got to me wondering why some products that belong to the same family as aspirin (such as the topical SA peel I mentioned) carry the warnings and others don't. That got me thinking about all the topical SA products that I use and if the absorption via the skin is enough to cause an increase ulcer formation risk. I mean SA is in just about every anti-aging, acne, hyperpigmention, wrinkle, fine-line skin product on the market so I'm wondering if these products will cause RNY patients any harm.
HW & SW: 363 Surgery date: 8/22/11
I think the reason some of these products have warnings and some do not are because of how they are marketed. I think things marketed as medications, pain relievers, etc, have to have warning versus products mostly marketed for cosmetic use.
I wonder if a sharp dermatologist would be of any help. I am leaning towards thinking that absorbtion varies widely. It seems that someone with dry skin might absorb more than oily skin.
I also wonder if there is a way to do a blood test to see how much salycylates are absorbed, although I blanch to think how much that would cost.
What is your surgeon's stance on NSAIDS?
I see the dilemna you face and maybe something to consider might be to use your aspirin mask but also to take a ppi as well.
I wonder if a sharp dermatologist would be of any help. I am leaning towards thinking that absorbtion varies widely. It seems that someone with dry skin might absorb more than oily skin.
I also wonder if there is a way to do a blood test to see how much salycylates are absorbed, although I blanch to think how much that would cost.
What is your surgeon's stance on NSAIDS?
I see the dilemna you face and maybe something to consider might be to use your aspirin mask but also to take a ppi as well.
Hillary, I had wondered about a similar situation I has a few weeks ago. I didn't use aspercreme, but instead used the salon pas medicated adhesive pads. The active ingredients are methyl salicylate, camphor and menthol. I researched the whole salicylate through the skin thing and found out very little. I then approached my pharmacist, and he couldn't confirm how much would be absorbed, and that there was some risk, however I did learn that the methyl salicylate yes is an aspirin-like analgesic, it's not an NSAID. It's grouped with NSAIDs because of the deleterious (rough) effects on the stomach, it's not truly a non-steroidal anti-inflammatory, more just an analgesic.
What I opted to do was limit the use and when I did have the need to use an adhesive patch, I took either a Prevacid or such when I used it. That was my choice though. I never asked my surgeon, and the pharmacist while very informed couldn't completely rule out the NSAID side effect.
Anyway, that's what I now know.
What I opted to do was limit the use and when I did have the need to use an adhesive patch, I took either a Prevacid or such when I used it. That was my choice though. I never asked my surgeon, and the pharmacist while very informed couldn't completely rule out the NSAID side effect.
Anyway, that's what I now know.
"Just keep swimming." ~ Dorrie
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