Epiduo is a fixed combination of Adapalene (0.1%) and Benzoyl Peroxide (2.5%) Gel. It’s a prescription drug with a list price of $400 (!) and street price at CVS of $170 (!). Adding the Dermatologist’s fee, the out of pocket cost of getting one tube of Epiduo can reach >$100.
The good news about Epiduo:
The good news is that Epiduo has in it benzoyl peroxide which is the best single anti-acne ingredients out there. Benzoyl peroxide is on the top of the topical treatment list of the American Academy of Dermatology acne treatment guidelines. Unfortunately, Adapalene (sold also over the counter as Differin) is mostly effective on comedones with significantly less effect on the real, red inflammatory acne pimples.
The bad news about Epiduo:
The downside the combination of these 2 ingredients is the significant skin dryness it produces. The main cause of the extreme irritation many Epiduo users complain about is the Adapalene. Similar adverse effects are seen when Adapalene is used alone in the over the counter Differin gel. Some users of Epiduo complain that the Epiduo caused a flare in their acne in the first weeks of use. This effect, similar to Accutane induced acne flare-ups, is not desirable and may increase the risk of scars at are the end of the treatment.
Why is Epiduo more irritating than any other anti-acne gel?
Dryness and irritation are not a good thing in acne treatment and should be avoided. Once the skin is over irritated by products like Epiduo or Differin the skin barrier of the skin is damaged, causing more inflammation that slows down skin healing and increases the risk for acne breakouts.
Old and simple formulations of 5% benzoyl peroxide can also irritate and dry the skin. Fortunately, new benzoyl peroxide formulations use a special microparticle benzoyl peroxide and anti-inflammatory ingredients. These special formulations reduce the irritation that was common with old formulations and further improve the efficacy of this great topical treatment. Customizing the % of Benzoyl peroxide to the skin type and acne severity of the specific user can maximize efficacy and reduce redness and irritation.
Is Epiduo more effective than the new micronized benzoyl peroxide anti-acne medications?
Regarding efficacy, it seems that the Epiduo has similar efficacy to benzoyl peroxide products but with significantly higher irritation. As this combination of a highly irritating compound (Adapalene) with regular BP is not tolerated by most users it may hurt commitment to treatment and reduce treatment success with this product.
In acne, more expensive is not necessarily better. New formulations of the highly effective micronized benzoyl peroxide, are affordable, significantly less irritating and more effective than higher priced prescription topical.