Benzoyl Peroxide for Acne

What Is Benzoyl Peroxide?

Benzoyl peroxide for acne treatment is well established. Benzoyl peroxide (BPO) is an anti-septic and a strong oxidising agent. BPO is capable of killing bacteria (we call this the bactericidal effect) by disrupting critical components of the bacterial cell wall. BPO is commonly found off the shelves in various formations and concentrations. BPO can be found in gels, creams and facial washes. Common concentrations in the market include BPO 2.5%, 5% and 10%.

Why Is Benzoyl Peroxide Important?

There are 4 main factors contributing to acne. These include an overactive sebaceous gland, abnormal keratinization within the hair follicle, inflammation and colonization of bacteria. Cutibacterium acnes (C.acnes) plays a vital role in the formation of Acne Vulgaris. 

Incorporating benzoyl peroxide for acne treatment therefore helps to reduce C.acnes colonisation and diminish antibiotic-resistant C.acnes strains. Treating solely with a topical or an oral antibiotic would substantially increase antibiotic resistance and make it harder to treat your acne. Nowadays, many topical creams comprise of a fixed combination of medicines to treat your acne. Common examples include Clindoxyl gel (Clindamycin + BPO) and Epiduo gel (Adapalene + BPO).

If your are suffering from moderate Acne Vulgaris where inflammation is predominant, your doctor may prescribe an oral antibiotic. However, it is good practice to integrate BPO into your treatment regime to reduce antibiotic resistance and enhance your treatment success.

Are There Side Effects with Benzoyl Peroxide?

Despite benzoyl peroxide treatments being an familiar go to product for acne, many individuals often complain of the dryness, redness, itchiness and peeling of the skin. While some doctors may recommend short contact therapy to reduce side effects, studies have been scarce as to the duration and concentration to leave BPO on the skin before you should wash it off.

Minimal Contact Time for Benzoyl Peroxide to Kill off C.acnes

Fortunately, a recent experimental in vitro study shed some light on the contact time of BPO with respect to its concentration. C.acnes was isolated from over 90 participants in this study. Different concentations of BPO was added and the minimal inhibitory concentration (MIC) was determined. MIC is defined as the lowest concentration at which the drug inhibited bacterial growth.

Results from this study shows:

• Lower concentrations of BPO (<2.5%) required more time to kill off C.acnes
• BPO concentrations of 5% or higher have swift bactericidal effects, and may be more suitable to use used as a rinse-off formulation.
• BPO is effective against both antibiotic-resistant and antibiotic-suspectible to C.acnes strains

Median contact time for Bactericidal effects of BPO depended on their concentration:

• BPO 1.25 % (60 minutes)
• BPO 2.5% (15 minutes)
• BPO 5% ( 30 seconds)
• BPO 10% (30 seconds)

Recommendations:

• If you have sensitive skin, it is best to start with the lowest concentration of BPO you can find.
• Use with a light weight moisturiser to buffer against BPO side effects.
• Start with a reduced frequency of BPO application and gradually increase once your skin gets used to it.
• 30 seconds contact time may be enough if you are using BPO concentration of 5%.

Summary

Benzoyl peroxide for acne plays an integral role whether as part of treating an acute flare of acne vulgaris or part of your maintenance treatment regimen. Although benzoyl peroxide is effective, it has common side effects, therefore choosing the right concentration and contact time will be important for patients who may have sensitive skin or sensitive to benzoyl peroxide for acne treatment.

References:

1. Boonchaya, P., Rojhirunsakool, S., Kamanamool, N., Khunkhet, S., Yooyongsatit, S., Udompataikul, M., & Taweechotipatr, M. (2022). Minimum Contact Time of 1.25%, 2.5%, 5%, and 10% Benzoyl Peroxide for a Bactericidal Effect Against Cutibacterium acnes. Clinical, cosmetic and investigational dermatology, 15, 403–409. https://doi.org/10.2147/CCID.S359055

2. Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009;10(15):2555–2562. 

3.Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018;78(2):S1–S23.