Benzoyl peroxide (BPO) has been used as an anti-acne treatment for several decades. Its unique activity is based on the ability to not only reduce Propionibacterium acnes, but also to decrease inflammatory lesions. As is well-known, P. acnes is the bacteria responsible for acne breakouts and it cannot live in an aerobic (i.e., oxygen-rich) environment. Benzoyl peroxide works by introducing oxygen into the pore, thereby killing the bacteria and, in turn, reducing the number of breakouts on the skin. And since BPO acts as a toxin on P. acnes rather than an antibiotic, resistance to BPO does not occur and has not been reported. Another factor that makes benzoyl peroxide so effective is its ability to help rid the follicle of excess dead skin cells since clearing the pore of cellular debris lessens the chances of pore blockages, or comedones. In this way, benzoyl peroxide helps to prevent breakouts before they start.
Regarding its regulation, the final Federal Register monograph of the US Food and Drug Administration (FDA), published on March 4, 2010, classified BPO as a safe and effective over-the-counter (OTC) topical acne drug product. This monograph went into effect on March 4, 2011, having taken more than 20 years to establish due to safety precautions. The monograph permits the use of BPO at levels between 2.5% and 10.0%; common commercial drug products, such as wash-off or leave-on gels or creams, typically use concentrations of 2.5% and 5.0%, up to 10.0%.
BPO commonly causes initial dryness and sometimes irritation, although skin tolerance usually occurs after a week or so.2, 8 However, a small percentage of individuals are much more sensitive to it and can suffer burning, itching, peeling and possibly swelling. It therefore is sensible to apply the lowest concentration to build up skin’s tolerance, as appropriate. Once tolerance is achieved, increasing the quantity or concentration a second time and gaining tolerance at a higher level usually gives better subsequent acne clearance.2, 9