Benzoyl peroxide is effective for reducing the number and severity of acne lesions. BPO has a bactericidal effect on Propionibacterium acnes bacteria associated with acne and does not induce antibiotic resistance.[11][12] It may be combined with salicylic acid, sulfur, erythromycin or clindamycin (antibiotics), or adapalene (a synthetic retinoid). Two common combination drugs include benzoyl peroxide/clindamycin and adapalene/benzoyl peroxide, an unusual formulation considering most retinoids are deactivated by peroxides. Combination products such as benzoyl peroxide/clindamycin and benzoyl peroxide/salicylic acid appear to be slightly more effective than benzoyl peroxide alone for the treatment of acne lesions.[12]
Benzoyl peroxide for acne treatment is typically applied to the affected areas in gel, cream, or liquid, in concentrations of 2.5% increasing through 5.0%, and up to 10%.[11] No strong evidence supports the idea that higher concentrations of benzoyl peroxide are more effective than lower concentrations.[11]
Benzoyl peroxide commonly causes initial dryness and sometimes irritation, although the skin develops tolerance after a week or so. A small percentage of people are much more sensitive to it and liable to suffer burning, itching, crusting, and possibly swelling.[13] It is sensible to apply the lowest concentration and build up as appropriate. Once tolerance is achieved, increasing the quantity or concentration and gaining tolerance at a higher level may give better subsequent acne clearance.[14] Irritation can also be reduced by avoiding harsh facial cleansers and wearing sunscreen prior to sun exposure.[14]
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