Can patients with eczema use benzoyl peroxide?

Benzoyl Peroxide Use in Patients with Eczema

Patients with eczema should generally avoid benzoyl peroxide as it can potentially exacerbate skin irritation, dryness, and inflammation in those with compromised skin barriers.

Risks of Benzoyl Peroxide in Eczema Patients

• Benzoyl peroxide is known to have a strong irritant effect on the skin, which can be particularly problematic for patients with eczema who already have a compromised skin barrier 1, 2
• Common adverse effects include erythema, scaling, dry skin, burning/stinging, skin discomfort, pruritus, and desquamation, which can worsen existing eczema symptoms 3, 1
• Benzoyl peroxide can cause allergic contact dermatitis and, in rare cases, more severe reactions like angioedema 4, 2
• The FDA label specifically warns about skin irritation characterized by redness, burning, itching, peeling, or swelling, which are particularly concerning for eczema patients 1

Considerations for Treatment

• For patients with acne who also have eczema:

  • Consider alternative acne treatments with less irritation potential 3, 2
  • If benzoyl peroxide must be used, consider lower concentrations (2.5% instead of 5% or 10%) as they have similar efficacy with less irritation 5, 6
  • Short contact therapy (applying for a short period then washing off) may reduce irritation while maintaining some efficacy 2

• Special precautions if benzoyl peroxide is used:

  • Apply only to non-eczematous skin areas 3, 1
  • Use less frequently than typically recommended for non-eczema patients 1
  • Monitor closely for signs of irritation or worsening of eczema 1, 2
  • Discontinue immediately if eczema flares or irritation occurs 1

Alternative Acne Treatments for Eczema Patients

• Topical retinoids with careful titration and moisturizer use may be better tolerated in some patients 3, 7
• For inflammatory acne in eczema patients, consider:
  • Topical clindamycin (without benzoyl peroxide) 3, 8
  • Azelaic acid, which has a better tolerability profile 9
  • For moderate-severe cases, systemic options like doxycycline may be preferable to topical irritants 7

Monitoring and Management

• If benzoyl peroxide is attempted:
  • Start with the lowest effective concentration (2.5%) 5, 6
  • Apply every other day or less frequently initially 1
  • Use generous moisturization after skin has dried following application 3, 1
  • Avoid combining with other potentially irritating topical products 3
  • Discontinue if any signs of increased skin irritation, dryness, or eczema flare occur 1, 2

Important Caveats

• Benzoyl peroxide can bleach hair and fabrics, requiring additional precautions 1
• Exposure to sunlight should be minimized during use, as it may increase irritation 3, 1
• Weather extremes (wind, cold) may further irritate skin when using benzoyl peroxide 3
• Pediatric patients with eczema require extra caution, though benzoyl peroxide has been used safely in children 9 years and older for acne 3