There are many over-the-counter (OTC) preparations for the treatment of acne. Sold as lotions, gels, creams, and cleansers, OTC products can be a precarious purchase, and consumers should be aware that chemicals applied to the skin can also be absorbed into the body. The possible adverse effects of chemical agents make natural skin care products appear more attractive.
This is especially true for skin conditions like acne and rosacea, as harsh chemicals can only make things worse. Synthetic chemicals can induce unnecessary inflammation beyond the confines of the sebaceous glands, resulting in acne scarring. Additionally, some chemicals can even be absorbed through the skin and have varying levels of systemic toxicity.
Benzoyl peroxide, the first topical agent for acne vulgaris, remains the most widely used over-the-counter acne treatment in the United States. It is inexpensive to manufacture and widely marketed. Benzoyl peroxide dissolves comedones and has a bactericidal effect by oxidizing the proteins of the offending microbe, P. acne (Leyden, 1997). Although it can be effective for mild acne, benzoyl peroxide is not free of adverse effects according to the European Commission.
The most common adverse effect is extreme dryness and premature aging of the skin of the skin. It can also cause skin irritation, stinging, burning, and scaling. A formulation containing 2.5% benzoyl peroxide was found to have less burning and scaling of the skin compared to 5% or 10% benzoyl peroxide (Mills et al. 1986). Allergic contact dermatitis was found in 1-2% of patients using benzoyl peroxide (Ives, 1992). May cause discoloration of hair and clothing.
Temporary skin discoloration may occur if benzoyl peroxide is used with sunscreen containing para-aminobenzoic acid (PABA). Similarly, concomitant use of benzoyl peroxide with tretinoin may cause severe skin irritation. Benzoyl peroxide should not be used during pregnancy as its safety during pregnancy is not documented. Safety in lactating women and children has also not been established.
In animal studies, it was found to induce skin cancer after 1 year of use (Kraus et al. 1995). Long-term studies are needed to outline its adverse effect in humans. The use of benzoyl peroxide in cosmetics has been banned by the European Union. Over-the-counter acne treatments containing benzoyl peroxide fall under this ban across Europe.
Acne preparations made from benzoyl peroxide may contain various other chemical ingredients. Glycolic acid is a photosensitizer and can be toxic to the gastrointestinal system, nervous system, and kidneys. Triethanolamine may form carcinogenic nitrosamine compounds on the skin or in the body after absorption. It can also cause an immune reaction in the form of allergic dermatitis or asthma attacks. Diisopropanolamine may release carcinogenic nitrosamine compounds.
While benzoyl peroxide can be used for the short-term treatment of mild acne in the US, its long-term use has the potential to damage the skin. In general, safer options that allow natural acne resolution are recommended. Natural alternatives to benzoyl peroxide are calendula or tea tree oil (Bassett et al. 1990). Leaf extracts of Psidium guajava and Juglans regia were found to be beneficial in treating acne (Qadan et al. 2005). Granulisin peptides were also found to be effective against P. acne and may form an alternative acne therapy in the future (McInturff et al. 2005).
If acne is severe and cannot be treated with benzoyl peroxide, a dermatologist should be consulted for prescription medications such as topical retinoids (tretinoin, adapalene, and tazarotene), topical antibiotics (clindamycin, erythromycin), oral isotretinoin, oral antibiotics ( doxycycline, minocycline).
References:
1. Leyden JJ (1997) Therapy for acne vulgaris. New England Journal of Medicine 336, 1156-62.
2. Ives TJ (1992) Benzoyl peroxide, Am Pharm NS32(8), 33-8.
3. Kraus AL, Munro IC, Orr JC, Binder RL, LeBoeuf RA, Williams GM (1995) Benzoyl peroxide: an integrated human safety assessment for carcinogenicity, Regul Toxicol Pharmacol 21, 87-107.
4. Mills OH Jr, Kligman AM, Pochi P, Committee H (1986) Comparison of 2.5%, 5% and 10% benzoyl peroxide in inflammatory acne vulgaris, Int J Dermatol 25, 664-7.
5. Bassett IB, Pannowitz DL, Barnetson RS (1990) A comparative study of tea tree oil versus benzoyl peroxide in the treatment of acne. Med J Aust, 153: 455-8.
6. Qadan F, Thewaini AJ, Ali DA, Afifi R, Elkhawad A, Matalka KZ (2005) Antimicrobial activities of Psidium guajava and Juglans regia leaf extracts against acne.
developing organisms. I am J Chin Med 33,197-204.
7. McInturff JE, Wang SJ, Machleidt T, Lin TR, Oren A, Hertz CJ, Krutzik SR, Hart S, Zeh K, Anderson DH, Gallo RL, Modlin RL, Kim J (2005) Granulysin-derived peptides demonstrate activity Antimicrobial and anti-inflammatory effects against Propionibacterium acnes. J Invest Dermatol 125, 256-63.