II. Indication

III. Mechanism

  1. Comedolytic
  2. Kills follicular Bacteria (esp. the Gram Positive organism, Propionibacterium acnes)
  3. Resistance cannot develop to Benzoyl Peroxide
    1. Benzoyl Peroxide should be considered in every Acne Vulgaris Management strategy
    2. Reduces Antibiotic Resistance risk in protocols using oral or systemic antibiotics

IV. Preparations

  1. Benzoyl Peroxide alone
    1. Cream 5%, 10%
    2. Gel 2.5%, 5%, 10%
    3. Lotion 5%, 10%
  2. Combination
    1. Benzoyl Peroxide with Clindamycin (Benzaclin)
    2. Benzoyl Peroxide with Erythromycin (Benzamycin)
      1. Gel 50 mg Benzoyl Peroxide and 30 mg Erythromycin
      2. Apply to skin bid, morning & evening
      3. May cause skin dryness, erythema, Pruritus
    3. Benzoyl Peroxide/sulfur (Sulfoxyl Regular or Strong)
      1. Lotion
        1. Benzoyl 5%, Sulfur 2%
        2. Benzoyl 10%, Sulfur 5%
      2. Apply daily to twice daily
      3. May cause skin dryness and Contact Dermatitis

V. Dosing

  1. Start with 2.5% or 5% (less irritating)
    1. Typically applied in the morning
  2. Apply to clean skin each day for 3 days
    1. Apply to region of skin (not only over comedones)
  3. Slowly increase strength of application
    1. However 10% preparations are likely to cause more irritation without significant increased benefit
    2. Often alternated with topical Retinoids (e.g. Benzoyl Peroxide in AM, Retin A in PM)
  4. Later increase time left on skin

VI. Advantages

  1. Least expensive Comedolytic ($4 per 30 grams in 2017)
  2. Safe in pregnancy

VII. Adverse Effects

  1. May cause skin dryness or irritation (burning,redness, stinging, peeling)
    1. Use water based instead of acetone or Alcohol product
    2. Use Lotion or cream instead of gel
  2. Bleaches hair, skin and clothing

VIII. Precautions

  1. As of 2024, FDA is looking into reports of Benzoyl Peroxide degradation (esp. when exposed to high Temperatures)
    1. Store Benzoyl Peroxide in a cool environment (or refrigerator)
    2. Avoid keeping Benzoyl Peroxide bottles in hot environments (e.g. hot car, shower)
    3. Replace expired bottles
    4. (2024) Presc Lett 31(5): 26-7

IX. References

  1. (2017) Presc Lett 24(1): 3

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Related Studies

Cost: Medications

benzoyl peroxide (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BENZOYL PEROXIDE 10% GEL Generic OTC $0.22 per gram
BENZOYL PEROXIDE 10% WASH Generic OTC $0.05 per gram
BENZOYL PEROXIDE 2.5% GEL Generic OTC $0.21 per gram
BENZOYL PEROXIDE 5% GEL Generic OTC $0.23 per gram
BENZOYL PEROXIDE 5% WASH Generic OTC $0.03 per ml