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Last updated: Dec 13, 2021
6 min read

Benzoyl peroxide for acne: how does it work?

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

If you’re one of the 50 million Americans living with acne, you’ve probably attempted to get rid of pimples and breakouts with various treatments (Hauk, 2017). 

You may even have a bathroom drawer full of skincare products. If so, some of those products likely contain benzoyl peroxide—a medication in many over-the-counter and prescription acne treatments. Benzoyl peroxide is a topical (applied-to-the-skin) medication and does not come in an oral (by mouth) form.  

Keep reading to learn more about benzoyl peroxide, if and how it works for acne, and how it compares to other products on the market.

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What is benzoyl peroxide?

Benzoyl peroxide is a topical medication used to treat acne. It is available over-the-counter (OTC) in a range of strengths (2.5% to 10%) and is an active ingredient in many OTC foams, spot treatments, lotions, gels, solutions, and cleansers (Matin, 2020). 

Benzoyl peroxide is also an ingredient in some prescription (Rx) acne medications. Here are a few Rx-only examples ([email protected], n.d.):

  • Acanya gel (benzoyl peroxide and clindamycin phosphate)
  • Benzamycin gel (benzoyl peroxide and erythromycin)
  • Epiduo gel (adapalene and benzoyl peroxide)
  • Twyneo cream (benzoyl peroxide and tretinoin)

Who should use OTC vs. Rx benzoyl peroxide?

If you have mild acne or small blemishes, you may be able to treat it yourself using an OTC benzoyl peroxide product (Hauk, 2017). They are cheap, convenient (no Rx required), and there are many options to choose from. A few examples of OTC products that contain benzoyl peroxide are Clearasil, Neutrogena, PanOxyl, Persa-Gel, and Proactiv. However, you should check with your doctor before using OTC acne medications if you’re currently pregnant or breastfeeding.

A “wash-off” version of OTC benzoyl peroxide, such as a body wash, may be a better option if you have breakouts on larger areas like your chest and back. “Leave-on” forms of benzoyl peroxide include things like lotions, spot treatments, and creams that you’ll apply directly to blemishes according to the package instructions. If you need help choosing, visit a brick-and-mortar drugstore and ask the pharmacist for a recommendation. 

If your acne is severe or doesn’t improve after using OTC benzoyl peroxide, seeing a dermatologist is the best thing to do. They can offer you personalized medical advice on effective treatments that would be best for your skin and acne type (Graber, 2020).

Topical acne medications that require an Rx often combine benzoyl peroxide with other medications, which may work better than benzoyl peroxide by itself (Matin, 2020). Keep in mind that benzoyl peroxide—regardless of whether it is OTC or Rx—will not clear up your acne right away. You’ll need to keep using it consistently, and it may take at least three weeks before you see improvement (Zaenglein, 2016). 

How does benzoyl peroxide work?

Acne breakouts start when skin cells and sebum (oil) clog your pores. Too much oil leads to an overgrowth of bacteria on the skin called Cutibacterium acnes (C. acnes) (Graber, 2020). 

Benzoyl peroxide works to clear acne by killing this bacteria. Benzoyl peroxide also helps with acne because it reduces your skin’s production of pore-clogging oil and helps to get rid of dead skin cells (Matin, 2020).

Is benzoyl peroxide good for acne?

Individual results may vary, but benzoyl peroxide can effectively treat mild-to-moderate acne. Clinical studies have shown that benzoyl peroxide can drastically reduce acne-causing bacterial overgrowth on the skin after one week of treatment (Kircik, 2013).

So, if you have mild or occasional acne, benzoyl peroxide is worth trying. Healthcare practitioners recommend benzoyl peroxide as a first-line treatment option for mild acne or as part of a combination approach for treating moderate acne (Hauk, 2017). 

Sometimes, benzoyl peroxide works better when you use it with other acne treatments like the topical retinoid, tretinoin (see Important Safety Information), or antibiotics like clindamycin or erythromycin. Using a topical antibiotic such as clindamycin or erythromycin by itself doesn’t work as well for acne because acne-causing bacteria can become resistant to them (Matin, 2020; Hauk, 2017). But these other acne medications require an Rx, so you’ll need to see a healthcare provider or dermatologist first.

For benzoyl peroxide to work, you’ll need to use it consistently. According to the American Academy of Dermatology, you can expect some improvements by the third week of treatment with benzoyl peroxide, with maximum benefits in about 8 to 12 weeks. Keep in mind that you will need to continue using benzoyl peroxide to maintain its benefits (Zaenglein, 2016).

Benzoyl peroxide side effects

Benzoyl peroxide can cause mild side effects, which may go away over time; these include skin dryness, irritation, reddening, and flaking (Graber, 2020; Matin, 2020).

Skin dryness and irritation are more likely to occur if you also use another topical acne medication at the same time as benzoyl peroxide. With OTC benzoyl peroxide, you may be able to reduce the irritation by just using one product, using it less often (like every other day instead of every day), or using it in a lower concentration. However, prior to making any changes to your Rx acne medications, reach out to your healthcare provider (Axia, 2019).

Benzoyl peroxide can also make your skin more sensitive to sunlight. Be sure to use sunscreen and protect your skin from unnecessary sun exposure. If you already have sensitive skin, a wash-off preparation of benzoyl peroxide (i.e., a cleanser) may be a better choice for you than a leave-on product (Axia, 2019; Zaenglein, 2016; Tan, 2018).

Allergic reactions, such as skin rash, itching, irritation, and inflammation, are also possible with benzoyl peroxide. So, when you’re choosing an OTC benzoyl peroxide, it’s a good idea to start with a low strength (like 2.5%) and apply the product to just a small area of your face for the first three days or so, especially if you have sensitive skin. If these symptoms don’t go away or become severe, stop using the product (Graber, 2020; Axia, 2019).

How to use benzoyl peroxide

People usually use benzoyl peroxide products once or twice a day. Be sure to follow the OTC label’s directions or your prescriber’s Rx instructions for how to use the product, and keep these tips in mind to help minimize side effects like skin dryness or irritation (Matin, 2020; Zaenglein, 2016; Axia, 2019):

  • Start with just one application per day in a thin layer, avoiding your eyes and mouth.
  • Since benzoyl peroxide may cause skin dryness, be sure to follow it with a moisturizer. Wait until the product has absorbed into your skin (or after your skin has dried if you’re using a wash-off form of benzoyl peroxide), then apply your moisturizer and sunscreen.  
  • Choose “non-comedogenic” moisturizers. These moisturizers are less likely to clog your pores (Graber, 2020).
  • If bothersome side effects occur, such as irritation or flaking, try using the product every other day versus daily until they go away.

Note that benzoyl peroxide can bleach hair or fabrics, so you’ll want to be careful not to get it on your hair, clothes, towels, etc.

Benzoyl peroxide vs. salicylic acid

When you’re looking at drugstore acne medications, you’ll notice that another common active ingredient is salicylic acid. It’s a topical acne medication available in leave-on and wash-off formulations that treats acne by decreasing inflammation, unclogging blocked skin pores, and helping remove dead skin cells (Tan, 2018).

There is limited clinical trial evidence that salicylic acid is effective for acne. However, combining benzoyl peroxide with salicylic acid may work for some people. This combination does increase the risk of skin irritation and dryness, so consider starting out with just one type of acne medication until you see how your skin responds (Tan, 2018).

Using benzoyl peroxide for acne: the bottom line 

Benzoyl peroxide can help improve acne when it is used consistently. However, if you have sensitive skin, you may not be able to tolerate it.

If you have tried using over-the-counter benzoyl peroxide or other acne treatments for more than three months and your acne has not improved, or if it is severe, reach out to your healthcare provider or dermatologist. 

References

  1. Axia Medical Solutions LLC. (2019). Benzoyl peroxide 10% gel. Retrieved Dec. 7, 2021 from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8cb19ffe-f7c0-4500-a56d-234fd8871f87&type=display 
  2. [email protected] (n.d.). FDA-approved drugs. Retrieved Dec. 7, 2021 from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process 
  3. Graber, E. (2020). Patient education: acne (beyond the basics). In R. P. Dellavalle & C. O. Owen (Eds.). Retrieved Dec. 7, 2021 from https://www.uptodate.com/contents/acne-beyond-the-basics 
  4. Hauk, L. (2017). Acne vulgaris: treatment guidelines from the AAD. American Family Physician, 95(11), 740–741. Retrieved from https://www.aafp.org/pubs/afp/issues/2017/0601/p740.html
  5. Kircik, L. H. (2013). The role of benzoyl peroxide in the new treatment paradigm for acne. Journal of Drugs in Dermatology, 12(6), s73–s76. Retrieved from https://jddonline.com/articles/dermatology/S1545961613S0073X 
  6. Matin, T. (2020). Benzoyl Peroxide. [Updated 2020, Nov 24]. In: StatPearls[Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537220/ 
  7. Tan, ​​A. (2018). Review of diagnosis and treatment of acne in adult female patients. International Journal of Women’s Dermatology, 4(2), 56–71. doi: 10.1016/j.ijwd.2017.10.006. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352647517300862?via%3Dihub 
  8. Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–73.e33. doi: 10.1016/j.jaad.2015.12.037 Retrieved from https://www.jaad.org/article/S0190-9622(15)02614-6/fulltext