Advancement in Benzoyl Peroxide-Based Acne Treatment: Methods to Increase Both Efficacy and Tolerability

Background: Antibiotic resistance of Propionibacterium acnes (P. acnes) is a growing phenomenon in the wake of widespread use of topical and systemic antibiotics for acne vulgaris. Benzoyl peroxide has a proven track record of safety and effi cacy, and can decrease reliance on antibiotics in the treatment of acne.
Purpose: To review the literature for methods to increase the effi cacy and tolerability of benzoyl peroxide (BPO).
Methods: A PubMed literature search was done using the terms “benzoyl peroxide,” “vehicle,” “mechanism,” and “delivery system.” Relevant papers were reviewed for methods of increasing BPO effi cacy and tolerability.
Results: BPO in concentrations of 2.5%, 5% and 10% are equally effective at treating infl ammatory acne. However, higher concentrations are associated with more adverse effects. The effi cacy of BPO may be enhanced by the presence of Vitamin E and tertiary amines. BPO is also more effi cacious if used in combination with topical retinoids than as a monotherapy. Novel vehicles including a microparticle delivery system and those with a hydrophase or urea base increase the tolerability of BPO without sacrifi cing effi cacy.
Conclusion: Benzoyl peroxide has a proven track record of safety and effi cacy for the treatment of acne. Recent discoveries have provided new methods of increasing the effi cacy and tolerability of topical BPO, making it useful as monotherapy for mild acne or as an adjunct in the treatment of moderate to severe acne vulgaris.