|Grade||Indication||Size of effect||Comments|
|A||Acne treatment||Strong||Reduces comedones, papules and pustules, and is suitable for long term maintenance therapy|
Benzoyl peroxide is part of the organic peroxide family with antibacterial and anti-inflammatory features. It can be found in the form of soaps, gels, washes and lotions with concentrations ranging from 1% to 10%. Gel formulations of benzoyl peroxide may be preferred over creams and lotions. It can sometimes be used in combination with other chemicals to help with dry and oily skin and/or with a antibiotic cream such as clindamycin and erythromycin. There have been numerous scientific trials proving effectiveness and safety.
When applied to the skin, it breaks down and releases oxygen reducing the growth of propionibacterium acnes, a bacteria associated in the formation of acne. It also increases cell turnaround, removing both mild blackheads and whiteheads (comedones) in the skin.
It should be applied to the entire affected area, usually in the morning and evening. It can be sometimes used in combination with a retinoid or topical antibiotic.
All medications have some side effects so it is important to be aware, however do not be alarmed. The most common side effect is skin irritation. Other side effects include erythema, peeling, and dryness but these can usually be reduced by using lower concentrations.
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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.