Benzoyl Peroxide

Aka: Benzoyl Peroxide

1. See Also
   1. Acne Vulgaris Pharmacologic Management
2. Indication
   1. Acne Vulgaris
3. 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
4. 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
5. 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
6. Advantages
   1. Least expensive Comedolytic ($4 per 30 grams in 2017)
   2. Safe in pregnancy
7. 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
8. References
   1. (2017) Presc Lett 24(1): 3