Is 10% benzoyl peroxide (BP) available over-the-counter?

Availability of 10% Benzoyl Peroxide Over-the-Counter

Yes, 10% benzoyl peroxide is available over-the-counter for acne treatment. 1, 2

Benzoyl Peroxide Overview

• Benzoyl peroxide (BP) is an over-the-counter topical antimicrobial agent that releases free oxygen radicals and has mild comedolytic properties 1
• BP is a mainstay of acne treatment with concentrations ranging from 2.5% to 10% available without prescription 2, 3
• BP works by:
  • Releasing free oxygen radicals that have antimicrobial effects 1
  • Providing mild comedolytic action 1
  • No reported development of bacterial resistance to BP, making it valuable for long-term acne management 1

Available Formulations

• BP is available over-the-counter in multiple concentrations:
  • 2.5% formulations 4
  • 5% formulations 2, 4
  • 10% formulations 2, 4
• Various delivery vehicles are available including:
  • Gels 1
  • Creams 1
  • Washes/cleansers 1, 5

Efficacy Considerations

• BP has demonstrated efficacy in multiple clinical trials with moderate certainty evidence from 8 studies 1
• Compared to vehicle at 12 weeks, BP shows:
  • Greater proportion of patients achieving treatment success (RR, 2.70 [1.10,6.65]) 1
  • Greater reductions in both inflammatory and noninflammatory lesion counts 1
• Efficacy is dose-dependent, but higher concentrations (10%) may not provide significantly better results than lower concentrations (2.5%) 6
• Clinical improvements typically become visible by the third week of therapy, with maximum lesion reduction after approximately 8-12 weeks 1

Side Effects and Tolerability

• BP use is limited by concentration-dependent side effects 1, 7:
  • Burning sensation
  • Stinging
  • Dryness
  • Erythema
  • Pain
  • Peeling
  • Irritation
  • Fabric staining and bleaching
  • Uncommon contact allergy
• Lower BP concentrations (2.5%) and water-based or wash-off formulations may be better tolerated 1, 6
• Risk of treatment discontinuation may be higher with BP compared to placebo or no treatment (RR 2.13,95% CI 1.55 to 2.93) 4

Clinical Considerations

• When selecting BP concentration, consider the balance between efficacy and tolerability 6
• 5% BP is often sufficient to control mild to moderate acne (grade I-II) 7
• BP should not be applied simultaneously with certain tretinoin formulations due to potential oxidation and inactivation 1
• BP may cause photosensitivity; concurrent daily sunscreen use is recommended 1
• BP can bleach colored and dark clothing, bedding, and even hair 7

Special Populations

• BP is pregnancy category C 1
• Safety and effectiveness have not been established in children under 12 years of age 1

While 10% BP is available over-the-counter, patients should be aware that higher concentrations may cause more irritation without necessarily providing better efficacy than lower concentrations 6. The 2.5% concentration has been shown to be as effective as 5% and 10% formulations in reducing inflammatory lesions while causing fewer side effects 6.