Benzoyl peroxide - 2020 update

Benzoyl peroxide - best antibiotic- free acne treatment

A recent clinical study published in the Journal of the American Academy of Dermatology examined the efficacy of a combination of benzoyl peroxide 5% gel with a liquid acne cleanser and moisturizer and moisturizer. The study revealed high efficacy and high levels of subject satisfaction, good adherence, and favorable treatment tolerability

What is benzoyl peroxide?

Benzoyl peroxide (BPO) is regarded as the most effective single anti-acne ingredient to treat acne. Benzoyl peroxide is effective in treating acne due to its suppression of bacterial proliferation, hyperkeratinization, and inflammation.

The American Academy of Dermatology regards benzoyl peroxide (BPO) as the single most effective topical anti-acne treatment medication. In addition to eliminating the acne bacteria, it reduces the risk of the potential for bacterial resistance. Topical BPO and antibiotics act by reducing P. acnes concentrations and suppressing inflammation. That said, BPO is more effective than topical antibiotics at the destruction of bacteria (90% reduction in P. acnes in seven days), and no bacterial resistance against BPO has been shown to date. In addition, BPO was proven to help unclog skin pores, reduce the production of free fatty acid on the skin, and reduce the number of blackheads and whiteheads.

As all other effective acne, topical treatment, it's used can cause some initial redness and dryness. These adverse effects can be now significantly reduced by personalizing the % of benzoyl used to the specific skin type for the user and by using specially formulated micronized forms of benzoyl peroxide are more effective and less irritating than the classic large molecule benzoyl peroxide formulations. Skincare products such as cleansers and moisturizers that complement prescribed therapies can also improve treatment tolerability and adherence.

Micronized benzoyl peroxide how it works

How was the study performed?

This new study published recently in the Journal of the American Academy of Dermatology evaluated subject satisfaction after the use of BPO 5% gel in combination with a mild cleanser and a moisturizer in fifty subjects > 12 years with mild-to-moderate facial acne. The face was washed with the cleanser twice daily, the BPO 5% gel was applied in the evening on clean and dry skin, and a moisturizer was applied in the morning for 12 weeks. Assessments included a subject satisfaction questionnaire, investigator global assessment, and global assessment of improvement, lesion counts, the presence of Propionibacterium acnes (P acnes) via UV fluorescence image analysis and safety.

What were the results of the study?

The results of the study show that nearly all subjects had a mean adherence to the treatment close to 100%. The vast majority (87%) expressed overall satisfaction with the three-part treatment regimen, while 92% were only slightly bothered or not bothered at all by side effects and felt better about themselves (94%). Most subjects confirmed the cosmetic aspects and positive effects of the skincare products such as preparation of the skin for treatment (85%), relief of itchy skin (81%), and reduction of irritation (87%). In addition, the subjects considered that the mild cleanser and the moisturizer helped them continue treatment (88% and 90%, respectively) and were a necessary part of acne treatment (80% and 83%, respectively). The treatment was efficacious, reducing the number of total lesions compared to baseline by 49% and 72% at weeks 4 and 12, respectively. The global assessment by the investigators showed improvement in approximately 90% of subjects. Moreover, BPO reduced P acnes by 89% and 74% at weeks 1 and 12, respectively. The combination was well tolerated, with mild skin irritation occurring mainly during the first week.


The conclusion of the authors was that the combination of BPO 5% gel a mild cleanser and moisturizer resulted in high levels of subject satisfaction in terms of clinical and cosmetic aspects of the treatment, good adherence, and a favorable tolerability profile. The subjects considered skincare products to be a necessary part of acne treatment. Interestingly, the results of these studies show efficacy that is significantly higher than other prescription acne medications that are available today (Epiduo, Differin) with minimal side effects and high adherence to the treatment.

More info on
Epidemiology and Management of Acne in Adult Women


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  2. Dreno B, Thiboutot D, Gollnick H, Bettoli V, Kang S, Leyden JJ, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol. 2014;24:330–334.
  3. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003;49:S1–S37.
  4. Hegemann L, Toso SM, Kitay K, Webster GF. Anti-inflammatory actions of benzoyl peroxide: effects on the generation of reactive oxygen species by leucocytes and the activity of protein kinase C and calmodulin. Br J Dermatol. 1994;130:569–575.
  5. Bojar RA, Cunliffe WJ, Holland KT. The short-term treatment of acne vulgaris with benzoyl peroxide: effects on the surface and follicular cutaneous microflora. Br J Dermatol. 1995;132:204–208.

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