Benzoyl peroxide has a good track record of safety and effectiveness for the treatment of mild acne. In some cases, effectiveness can be increased if used in combination with antibiotic or retinoid creams.

Benzoyl peroxide is considered as first line treatment for mild acne. Strong evidence from scientific studies show that benzoyl peroxide reduces both inflammatory and non-inflammatory lesions.

Benzoyl peroxide in concentrations of 2.5%, 5% and 10% have been shown to be equally effective however higher concentrations have been linked with more side effects.

Moderate acne responds well to combination therapy with benzoyl peroxide, antibiotics and/or retinoids.

Benzoyl peroxide combined with a topical antibiotic, such as clindamycin, has been shown to be effective in large randomised controlled clinical trials. A clinical trial compared the safety of the combinations clindamycin/benzoyl peroxide and adapalene/benzoyl peroxide in patients with mild-to-moderate acne. Results showed that clindamycin/benzoyl peroxide gel had less side effects.

Benzoyl peroxide and topical azelaic acid have also shown to reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.

There is some evidence of increased effectiveness when benzoyl peroxide is used alongside topical tretinoin (a retinoid). A clinical trial testing tretinoin lotion 0.05%, benzoyl peroxide 5% and 10% was carried out in 250 patients suffering from acne. The results showed that tretinoin applied in the morning and benzoyl peroxide applied at night was the most effective with minimal side effects.

Betty Anne Johnson MD, PhD & Julia R. Nunley MD (2000) Topical therapy for acne vulgaris, Postgraduate Medicine, 107:3, 69-80, DOI: 10.3810/pgm.2000.03.945

Mohd Nor NH, Aziz Z. A systematic review of benzoyl peroxide for acne vulgaris. Journal of Dermatological Treatment 2013; 24(5): 377-386.

National Center for Biotechnology Information. PubChem Compound Database; CID=7187, https://pubchem.ncbi.nlm.nih.gov/compound/7187 (accessed Sept. 27, 2017).

Chalker DK, Shalita A, Granham Smith J, et al. A double-blind double-blind group comparison study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vugaris. J Am Acad Dermatol 1983; 9: 933-6

Cks.nice.org.uk. (2017). Acne vulgaris - NICE CKS. [online] Available at: https://cks.nice.org.uk/acne-vulgaris#!scenario [Accessed 29 Sep. 2017].

Dreno, B. (2004). Topical Antibacterial Therapy for Acne Vulgaris. Drugs, 64(21), pp.2389-2397.

Thiboutot, D. (2000) New treatments and therapeutic strategies for acne. Archives of Family Medicine9(2), 179-187.

Purdy, S. and de Berker, D. (2011) Acne vulgaris.Clinical Evidence. BMJ Publishing Group Ltd.

HANDOJO, I. (1979). THE COMBINED USE OF TOPICAL BENZOYL PEROXIDE AND TRETINOIN IN THE TREATMENT OF ACNE VULGARIS. International Journal of Dermatology, 18(6), pp.489-496.

Gonzalez, P., Vila, R. and Cirigliano, M. (2012). The tolerability profile of clindamycin 1%/benzoyl peroxide 5% gel vs. adapalene 0.1%/benzoyl peroxide 2.5% gel for facial acne: results of a randomized, single-blind, split-face study. Journal of Cosmetic Dermatology, 11(4), pp.251-260.