From the Guidelines
Benzoyl peroxide gel is a highly effective first-line treatment for mild to moderate acne, and I strongly recommend using a 2.5% to 5% strength gel once or twice daily after washing your face with a gentle cleanser, as supported by the most recent guidelines from the Journal of the American Academy of Dermatology 1.
Key Points to Consider
- Start with a lower concentration and apply every other day, gradually increasing to daily use as your skin adjusts to minimize irritation.
- Apply a thin layer to affected areas, not just individual pimples, and allow it to dry completely before applying moisturizer.
- Most people see improvement within 4-6 weeks, but consistent use for 8-12 weeks is often needed for optimal results.
- Benzoyl peroxide works by killing acne-causing bacteria (P. acnes) and removing excess oil and dead skin cells that clog pores, and it also has anti-inflammatory properties that help reduce redness.
Management of Side Effects
- Common side effects include dryness, peeling, and skin irritation, which can be managed by using moisturizer and sunscreen daily.
- Benzoyl peroxide can bleach fabrics, so apply it well before bedtime and use white towels and pillowcases.
Combination Therapy for Severe Acne
- For more severe acne, combining benzoyl peroxide with other treatments like topical retinoids or antibiotics under medical supervision may be necessary, as recommended by the guidelines 1.
Evidence-Based Recommendations
- The guidelines provide strong recommendations for benzoyl peroxide, topical retinoids, and topical antibiotics, as well as oral doxycycline, and conditional recommendations for other treatments like clascoterone, salicylic acid, and azelaic acid 1.
From the FDA Drug Label
Use for the treatment of acne Active ingredient Benzoyl peroxide 5% Benzoyl peroxide 10% Purpose Acne treatment
The efficacy of benzoyl peroxide (BPO) gel in treating acne is supported as it is indicated for the treatment of acne 2 and 2.
- The active ingredient is benzoyl peroxide, which comes in concentrations of 5% and 10%.
- The purpose of the drug is acne treatment.
From the Research
Efficacy of Benzoyl Peroxide Gel in Treating Acne
- Benzoyl peroxide (BPO) gel has demonstrated clinical efficacy in the treatment of acne vulgaris through both antibacterial and anti-inflammatory means 3.
- The efficacy of BPO gel in reducing inflammatory lesion counts was greater than that of BPO alone, clindamycin alone, or vehicle in patients with mild to moderately severe acne 3, 4.
- BPO gel has a fairly rapid onset of action, with acne improvement usually recorded within 2-4 weeks 4.
- The combination of BPO with either erythromycin or clindamycin is synergistic and well-tolerated 5.
- BPO gel is safe and highly effective in the treatment of acne vulgaris, with its efficacy, tolerability, and ease-of-use being superior to other topical acne therapies 6.
Mechanisms of Action
- BPO may exert its antibacterial activity by the interaction of oxidized intermediates with elements of bacterial cells 3.
- BPO decreases inflammatory damage by inhibiting the release of reactive oxygen species from polymorphonuclear leukocytes (PMNs) through the killing of PMNs 3.
- BPO has a predominant antibacterial action, although it is not considered as an antibiotic in the classical sense 7.
Safety and Tolerability
- BPO gel is generally well tolerated, and the main treatment-related adverse events in clinical trials were application-site dryness, irritation, peeling, and erythema 3, 4.
- The most common adverse events were dry skin, peeling, erythema, and rash; however, adverse event-caused treatment discontinuation rates for patients using BPO gel were low, ranging from 0 to 0.8% 3.
- BPO is safe for use in pregnant and lactating females because it is degraded to benzoic acid 7.