Though mostly a prescription medication, benzoyl peroxide is a common component of most OTC acne products. It is an oxidizing agent and has antibacterial and anti-inflammatory properties which make benzoyl peroxide the topical medication of choice in pustular and papular types of acne.
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How Does Benzoyl Peroxide Help Get Rid Acne
The exact mode of action of benzoyl peroxide is not clearly understood yet, but its antibacterial activity against the P.acnes is thought to play a major role in its effectiveness against inflammatory acne. Patients treated with benzoyl peroxide show reduction in the sebum lipids and free fatty acids and show mild to moderate degree of drying and peeling of the superficial epidermal layer.
These combined actions result in an overall anti-inflammatory, antibacterial and antisebaceous effects and reduction in acne bumps.
For Which Types of Acne is Benzoyl Peroxide Useful
Benzoyl peroxide is more effective than topical erythromycin and clindamycin in mild to moderate inflammatory types of acne. It is less useful in comedonal acne, where topical retinoids are the medications of choice.
Some studies have shown the anti-acne activity of benzoyl peroxide at par with systemic antibiotics in the pustular variety of acne. In the moderate and severe types of acne, benzoyl peroxide is used as a combination therapy with systemic and/or topical antibiotics.
Patients with papular and pustular types of acne who cannot or would not take oral antibiotics, may be treated with topical isotretinoin at night and 2.5% benzoyl peroxide in the morning, adjusting the frequency and strength to avoid skin irritation.
How is Benzoyl Peroxide Applied in Acne
Except in temperate climates and in winter, it is better to apply benzoyl peroxide at night, as it may sensitize the skin to the sun. Some other things to consider when applying benzoyl peroxide include the following:
- Wash the face with a mild cleanser and water and dry the skin before applying benzoyl peroxide.
- A thin layer is applied to the whole acne prone area. If burning and stinging sensation occurs, wash off the medication after two hours. Once the skin becomes “acclimatized,” then the benzoyl peroxide may be left overnight. Alternatively, to start with, lower strength of 2.5% may be used in the initial weeks, later shifted to higher strengths, if needed.
- A reddish brown pigmentation is seen in some patients treated with benzoyl peroxide when the acne bumps heal. This is normal and will fade away gradually. These patients should wear a non-comedogenic sunscreens while outdoors during the daytime.
- In acne sufferers with oily and normal skins, start benzoyl peroxide at 5% strength. Reduce to 2.5% when the new acne eruptions stop appearing after three to four months. This may be continued for a further period of two to three months. Later, weekly maintenance therapy may be continued with topical retinoids for a few months to years.
What are the Adverse Effects of Benzoyl Peroxide? How to Deal with Them
Most patients on benzoyl peroxide experience mild burning or stinging sensation in the initial period of treatment.
- Excessive scaling, redness and swelling of the face may be either due to irritant reaction to excessive application of the benzoyl peroxide or allergic contact dermatitis reaction.
- In allergic contact dermatitis, there will be swelling and inflammatory changes on the skin beyond the area of application. Eyelids, lips and skin all over the face and neck and even remote areas of the upper limb and body may be affected.
- In excessive reaction, the irritation will be limited to the area of application.
- In either case, the medication should be stopped and cool compresses and soothing emollients should be applied till the skin returns to normal. Allergic contact dermatitis may require a short course of oral steroids.
- If any untoward reactions occur, you should stop the medication and consult your dermatologist.
- After the reaction subsides and the skin returns to normal, if only excess application is suspected, resume benzoyl peroxide application with lower strength, duration and frequency than before. For the first few days, apply it to a small area only and watch out for recurrence of irritation. If again irritation returns, try alternate topical medications for the acne.
- Take special care when you come in contact with other family members like children and spouses.
Benzoyl peroxide is a comparatively safe and effective topical anti-acne medication that can even be used in pregnancy and lactation; though it should be stressed that any medication should be used in pregnancy and lactation only if the benefits outweigh the risks in such situations.
