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Benzoyl Peroxide Treatment for Acne

Topical acne treatment has been a well known treatment for quite some time, and benzoyl peroxide is arguably the most widely used drug formations available. Benzoyl peroxide exhibits strong antimicrobial action, slight anti-inflammatory effects, and anticomedogenic attributes, making it a very effective first-choice medication for acne. Responses to treatment may be obtained within five days of initial use.

Treatment with Benzoyl Peroxide Alone

Treatment with benzoyl peroxide alone significantly improves inflammatory acne, with side effects limited to common irritant dermatitis with erythema, scaling, and itching. These side effects can be controlled by administering benzoyl peroxide less frequently or in smaller amounts. The incidence of true contact sensitivity is low, and benzoyl peroxide very rarely produces photosensitivity. Water-based benzoyl peroxide preparations with concentrations between 2.5% and 5.0% have been found to less irritating than preparations based in alcohol, but lost none of its potency. Perhaps the most disadvantage (not side effect) that a user has to be aware of is that benzoyl peroxide can bleach clothing and bedding.

A study was conducted recently to compare the efficacy of different gel benzoyl peroxide concentrations. A 2.5% formulation was as effective as 5% and 10% formulations, and less drying than both in reducing inflammatory lesions. Significant reductions of acne were seen after two weeks of application. Side effects were also less frequent and severe in the 2.5% and 5% formulations as opposed to the 10% formulation.

Combination Therapy

Antibiotic treatment has been known to induce bacterial resistance, reducing the efficacy of medication. The sharp increase of bacterial resistance to antibiotics in acne patients led experts to attempt using benzoyl peroxide in combination therapy.

Adding benzoyl peroxide to a topical drug that reduces bacterial resistance, for instance, is now a common combination treatment. Such treatment has been found to be more effective, as well as better tolerated, than if benzoyl peroxide was applied on its own. In one particular study, no changes were observed on an acne patient after applying 5% benzoyl peroxide gel twice daily for four weeks; however, the combination of erythromycin 3% and benzoyl peroxide 5% resulted in lowered antioxidant enzyme activities in the leukocytes of acne spots.

Even in combination therapy, however, benzoyl peroxide’s effectiveness as an anticomedogenic, antimicrobial and antibacterial agent is limited by its side effects of dryness and irritation. A 12-week, once-daily combination therapy of tretinoin 0.1% microsphere gel and benzoyl peroxide 6% cleanser was shown to be more effective in reducing inflammatory lesions (but not non-inflammatory ones), as opposed to using the tretinoin 0.1% microsphere gel alone, without any increase in local skin irritation.

Pre-mixed benzoyl peroxide combinations have recently made their way to drugstore shelves. Unlike older preparations that required refrigeration, these new formulations are stable at room temperature. Examples of pre-mixed benzoyl peroxide combinations include the following:

  • Erythromycin 3% and benzoyl peroxide 5%
  • Clindamycin 1% and benzoyl peroxide 5%

In patients with moderate to moderately severe acne, the latter sample was shown to reduce inflammatory and non-inflammatory lesions by 53% and 25% respectively after 11 weeks of treatment, with few side effects.