How Does Benzoyl Peroxide Work?

Benzoyl peroxide is a well-known treatment for acne vulgaris or acne. How does benzoyl peroxide work, what is it used for, and are there any side effects?

What is benzoyl peroxide?

Benzoyl peroxide is sold as either a prescription or an over-the-counter product, and it is applied topically to the skin to treat acne vulgaris.

It is available over the counter in a variety of forms, such as leave-on gels, spot treatments, and creams, and it can even be found in some facial cleansers.

It is also an active ingredient at work in some combination acne therapies that need a prescription, including Epiduo ® (adapalene and benzoyl peroxide), Benzaclin (clindamycin and benzoyl peroxide), and more.^1,2

Benzoyl peroxide has been around since the 1960s, and it was FDA-approved as an over-the-counter topical acne treatment in March 2010.³

It is also occasionally prescribed off-label to treat other skin concerns, such as inflammatory rosacea and some forms of folliculitis, among others.^4,5

How does benzoyl peroxide work?

Benzoyl peroxide works through a variety of mechanisms to help treat acne vulgaris.

First, it targets the bacterium Cutibacterium acnes; this is a type of bacteria naturally found on the skin, and it is thought to drive the formation of acne by encouraging buildup in the pores and inducing an inflammatory response.^4,6

More research is needed to determine the exact role of Cutibacterium acnes in the pathogenesis of acne vulgaris.

Benzoyl peroxide is converted to benzoic acid when absorbed into the skin, and this benzoic acid is metabolized by proteins on the skin to release reactive oxygen free radicals.7

These free radicals oxidize, and in turn chemically denature, the bacterial proteins of Cutibacterium acnes.⁴

Benzoyl peroxide is unique; although it has antibacterial properties, it has not been shown to cause antibiotic resistance.⁸ Antibiotic resistance refers to the development of antibiotic resistant bacteria, which are more difficult to treat than their regular counterparts.

When used with topical and oral antibiotics, which may be used to treat inflammatory acne, it has also been shown to reduce the risk of formation of antibiotic resistant bacteria that can result from the antibiotics.⁹ 

Benzoyl peroxide also has many other acne-fighting abilities; it can work as a peeling agent, help clear pores, and decrease the amount of free oils and fatty acids on the skin’s surface.¹⁰

Speaking with a healthcare provider could help you determine whether benzoyl peroxide, either over the counter or by prescription, would work for your skin type.

What are the side effects of benzoyl peroxide?

Some common side effects of benzoyl peroxide include dryness, flaking, peeling, redness, and irritation of the skin being treated.¹¹

It can also bleach hair or fabrics that it comes into contact with, so caution should be used when using products containing benzoyl peroxide.

Some rare and more severe side effects may include swelling, blistering, or contact dermatitis.¹¹

It is important to discuss any concerning side effects with your doctor or pharmacist, as they can help determine whether the medication needs to be adjusted or discontinued.

Benzoyl peroxide should not be used by those with an allergy to benzoyl peroxide.

Signs of a benzoyl peroxide allergy may include a skin rash, wheezing, chest tightness, or swelling of the mouth, throat, tongue, and face.¹¹ If these symptoms occur, seek immediate medical help.

Some other medications and skincare ingredients may not mix well with benzoyl peroxide. 

Using benzoyl peroxide with either topical dapsone, which is an antibiotic, or topical hydroquinone, may result in temporary skin staining.^12,13   

Applying benzoyl peroxide at the same time as some forms of tretinoin (Retin A), which is a topical retinoid, may reduce the effectiveness of the tretinoin.¹⁴ 

Benzoyl peroxide may interact with certain oral medications, so it is important to tell your doctor about all products, supplements, and medications you may be taking.

It is important to use broad-spectrum sunscreens that protect against UVA and UVB radiation and limit sun exposure while using benzoyl peroxide to prevent the risk of skin irritation and burning.⁴ 

This article is not medical advice, and it is not intended to prescribe, diagnose, or promote specific treatments for any condition.

References

1. Valeant Canada L.P. (2012, February 29). “BenzaClin” Topical Gel: Product Monograph. Montreal, QC: [online pdf]. Accessed 2021, May 5, from https://pdf.hres.ca/dpd_pm/00015735.PDF
2. Galderma Australia Pty Ltd (2019, February). Epiduo ® Gel: Consumer Medicine Information. New Zealand: [online pdf]. Accessed 2021, May 5, from https://www.galderma.com/sites/g/files/jcdfhc266/files/inline-files/Epiduo%20Gel%20CMI_Feb%202019_0.pdf
3. FDA. (2018, May 2). Rulemaking History for OTC Acne Drug Products. Accessed 2021, May 5, from https://www.fda.gov/drugs/status-otc-rulemakings/rulemaking-history-otc-acne-drug-products
4. Matin, T., Goodman, M.B. (2020, November 24). Benzoyl Peroxide. StatPearls [Internet]. Accessed 2021, May 5, from https://www.ncbi.nlm.nih.gov/books/NBK537220/ 
5. Leyden, J.L. (2004). Topical treatment for the inflamed lesion in acne, rosacea, and pseudofolliculitis barbae. Cutis 73(6): 4-5. Accessed 2021, May 5, from https://pubmed.ncbi.nlm.nih.gov/15228127/
6. Platsidaki, E., Dessinoti, C. (2018). Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne. F1000Res 7:F1000 Faculty Rev-1953. Doi: 10.12688/f1000research.15659.1
7. Nacht, S., Yeung, D., Beasley, J.N., Anjo, M.D., et al. (1981 January). Benzoyl peroxide: percutaneous penetration and metabolic disposition. J Am Acad Dermatol 4(1): 31-37. Doi: 10.1016/s0190-9622(81)70004-5.
8. Kircik, L.H. (2013, June). The role of benzoyl peroxide in the new treatment paradigm for acne. J Drugs Dermatol 12(6): s73-s76. Accessed 2021, May 5, from https://pubmed.ncbi.nlm.nih.gov/23839205/
9. Dutil, M. (2010, November-December). Benzoyl peroxide: enhancing antibiotic efficacy in acne management. Skin Therapy Lett 15(10): 5-7. Accessed 2021, May 6, from https://pubmed.ncbi.nlm.nih.gov/21076800/
10. Burkhart, C.G., Butcher, C., Burkhart, C.N., et al (2000, July 1). Effects of Benzoyl Peroxide on Lipogenesis in Sebaceous Glands using an Animal Model. Journal of Cutaneous Medicine and Surgery. Doi: 10.1177/120347540000400305
11. NHS (2019, September 6). Benzoyl Peroxide. NHS: UK. Accessed 2021, May 7, from https://www.nhs.uk/medicines/benzoyl-peroxide/
12. Dubina, M.I., Fleischer, A.B. (2009, September). Interaction of topical sulfacetamide and topical dapsone with benzoyl peroxide. Arch Dermatol 145(9): 1027-1029. Doi: 10.1001/archdermatol.2009.186
13. Saade, D.S., Maymone, M.B.C., Secemsky, E.A., et al (2018, July). Patterns of Over-the-counter Lightening Agent Use among Patients with Hyperpigmentation Disorders: A United-States-based Cohort Study. J Clin Aesthet Dermatol 11(7): 26-30. Accessed 2021, May 7, from https://pubmed.ncbi.nlm.nih.gov/30057662/
14. Del Rosso, J.Q., Pillai, R., Moore, R. (2010). Absence of Degradation of Tretinoin when Benzoyl Peroxide is Combined with an Optimized Formulation of Tretinoin Gel (0.05%). J Clin Aesthet Dermatol 3(10):26-28. Accessed 2021, May 7, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958193/
15. Image by AdoreBeautyNZ from Pixabay