Benzoyl peroxide effective treatment for acne

Results of a UK study in this week’s issue of THE LANCET highlight how over the counter benzoyl peroxide (BEN-zoe-ill per-OX-ide) lotion is as good as prescription antibiotics for the treatment of mild to moderate facial acne.

Benzoyl peroxide is primarily used in the treatment of acne vulgaris due to the antibacterial activity that these types of peroxides display. The drug is marketed under a variety of trade names in over 200 formulations. In treating patients with acne, the disappearance of acne coincides with the reduction of both the levels of P. acnes bacteria and free fatty acids. Benzoyl peroxide is absorbed in the skin where it is metabolized to benzoic acid and then excreted as benzoate in the urine. Side effects consist mainly of skin irritation including burning, blistering, crusting, itching, severe redness, and skin rash.

Facial acne is common among adolescents; antibiotic tablet treatment has been used extensively over the past 40 years. Concerns exist about increasing antibiotic resistance, and few studies have compared the efficacy and costeffectiveness of different treatment options for acne—including the comparison of tablet antibiotics and antibiotic lotions with the antimicrobial treatment benzoyl peroxide.

Hywel Williams and colleagues from the Universities of Nottingham and Leeds, UK, compared 5 treatment options for acne in a randomised trial involving around 650 participants. The treatments being compared were: the oral antibiotics oxytetracycline or minocycline, the topical antibiotic erythromycin, the antimicrobial lotion benzoyl peroxide, or a combination of topical erythromycin and benzoyl peroxide.

Most improvement occurred in the first 6 weeks of treatment. Self-reported improvements after 18 weeks were similar in all 5 treatment groups.

Professor Williams comments: “Differences in cost-effectiveness between regimens were large; the cheapest treatment (benzoyl peroxide) was 12 times more cost-effective than minocycline. We found that clinical efficacy of oral tetracyclines is compromised by pre-existing propionibacterial resistance. By contrast, topical regimens that included erythromycin and benzoyl peroxide were unaffected by resistance but were not superior to benzoyl peroxide alone.”