Benzoyl Peroxide For Inflammatory Acne – Top 11 Questions Answered

What is Benzoyl Peroxide and How Does It Work?

Benzoyl peroxide is a topical acne treatment that targets Cutibacterium acnes (C. acnes). In acne sufferers, these bacteria are increased on the surface of the skin. Benzoyl peroxide causes the oxidation of important structures within the bacteria, such as proteins in the cell wall. This disrupts the function of the bacteria, thus promoting an improvement in acne (1).

Is Benzoyl Peroxide Bad For Your Skin?

An early mention of benzoyl peroxide is evident in research by Lyon and Reynolds. In their article, they speak about the role of benzoyl peroxide in skin healing, and it’s anti-inflammatory effects (2). Unless you experience a severe reaction to benzoyl peroxide, there have been no serious long-term effects studied. Other than an increase in dryness and temporarily irritated skin, you are good to use it long-term.

Should Benzoyl Peroxide Be Left On Overnight?

Benzoyl peroxide comes in a few different forms of treatment. There are creams, gels, and washes. Creams, like my personal favourite, the Oxy Deep Pore Acne Vanishing Treatment, are able to be left on overnight. However, some people may find it irritating to leave this on overnight. In that case, face washes are a great option. They range from 2.5% to 10% concentrations. And since they are washed off, this reduces irritation on the skin. As another option, you can use short-contact therapy to reduce irritation. This involves washing the face with a non-medicated cleanser, then applying a cream or gel treatment that contains benzoyl peroxide to dry skin, leaving it on for 5 to 10 minutes, then washing it off with water. This reduces your chances of being irritated from this treatment. 

What Can You Mix With Benzoyl Peroxide?

Benzoyl peroxide can and should be used along with a good moisturizer. If you choose to use benzoyl peroxide in the morning, make sure you pair it with a great sunscreen. It is generally not recommended to use multiple acne treatments in one regimen. For example, if you are using salicylic acid as well, use one in the morning and one at night. 

However, the acne treatment that you should absolutely mix with benzoyl peroxide is adapalene. This is called an active ingredient. Adapalene is a retinoid that promotes exfoliation of the skin, has anti-inflammatory effects, and is stable enough to not degrade when used along with benzoyl peroxide (3).

But STOP!

If you have never used a retinoid before, it is important that you do not suddenly start a new skincare regimen with multiple acne treatments. This will lead to irritation and possibly more breakouts. 

Should I Moisturize Before or After Benzoyl Peroxide?

Like I mentioned above, it is important to use a moisturizer along with benzoyl peroxide, and any acne treatment for that matter. It is best to moisturize first, wait a couple of minutes for the product to sink into the skin, and then apply a benzoyl peroxide cream or gel to the affected areas. This order is especially important for those who are using an acne treatment for the first time. In this way, the skin is prepped for treatment and not prone to dryness and further irritation.

Do Benzoyl Peroxide Washes Work?

The best way to avoid excess irritation from benzoyl peroxide is to use it in the form of a face wash. Why? This allows you to wash off the product, rather than leaving it on. The less contact time it has with the skin, the less side effects. However, don’t be fooled! Benzoyl peroxide washes have been shown to effectively reduce the amount of C. acnes on the skin with only a 20 second contact time (4)!

Does Benzoyl Peroxide Make Your Skin Worse Before It Gets Better? 

This phenomena is also known as purging, or the initial exacerbation of acne lesions when starting a new acne treatment. This is most often seen when people begin using a retinoid treatment (5). However, when starting to use benzoyl peroxide, you may experience some redness and irritation. This will dissipate in a couple of weeks, as long as you are pairing the treatment with a great moisturizer. 

How Long Should I Leave Benzoyl Peroxide On My Face?  

The length of time you leave this treatment on the skin will vary depending on the individual needs of your skin. If you have very irritated skin, opt for a benzoyl peroxide face wash or do short-contact therapy as mentioned above.

When you first start using a benzoyl peroxide cream or gel, you can try leaving it on overnight, every other night. This way, you will get your skin accustomed to this new treatment, and it will reduce irritation on the skin. Once you have used the benzoyl peroxide in this manner for about 4 weeks, you can begin to use it nightly. Listen to your skin, and if you find it is becoming too irritated, reduce the number of times you use the treatment.

Is Benzoyl Peroxide Or Salicylic Acid Better?

Salicylic acid is a type of beta hydroxy acid that can be used as a topical treatment for acne. It dissolves easily in oil and can penetrate the skin, leading to a reduction in inflammatory areas by reducing the formation of comedones (6). In other words, it helps to unglue the rivets that hold skin cells together, stopping oil and debris from forming inflamed bumps on the skin. 

Now that I’ve explained what salicylic acid is, should you include it in your routine instead? It depends. Benzoyl peroxide is best for inflammatory skin conditions, as it directly targets the C. acnes bacteria. Salicylic acid is best suited for smaller whiteheads, or very mild acne, as it has some exfoliation properties. 

Can I Mix Benzoyl Peroxide and Salicylic Acid Together?

The short answer is no. At least, it’s recommended that you do not mix these two treatments together. Why? This is a recipe for irritated skin and over-exfoliation. These are both active ingredients, and should be used in separate regimens to avoid further inflammation. 

Can I Mix Benzoyl Peroxide and Retinol?

Retinols are a type of retinoid that can be used in the treatment of acne. They normalize desquamation, or the shedding of the outer layer of the skin, which helps to regulate skin exfoliation and reduces the formation of acne (7). Like I stated above, mixing multiple acne treatments can lead to skin irritation and an increase in skin redness. Further, it is worthy to mention that the retinoid tretinoin has been shown to not be stable in conjunction with benzoyl peroxide. When used with benzoyl peroxide and exposed to light, tretinoin was shown to be degraded up to 50% (8). While we don’t know the stability information for all over the counter retinol products, it is best to not mix benzoyl peroxide and retinol.

And there it is! These answers cover a wide range of questions regarding benzoyl peroxide. If you have any other questions, please leave it in the comments below!

References

1. Matin T, Goodman MB. Benzoyl Peroxide. [Updated 2020 Nov 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK537220/?report=classic
2. Lyon, R. A., & Reynolds, T. E. (1929). Promotion of Healing by Benzoyl Peroxide and Other Agents. Experimental Biology and Medicine, 27(2), 122–124. https://doi.org/10.3181/00379727-27-4636
3. Tolaymat L, Zito PM. Adapalene. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK482509/
4. What is the Role of Benzoyl Peroxide Cleansers in Acne Management?: Do they Decrease Propionibacterium acnes Counts? Do they Reduce Acne Lesions? J Clin Aesthet Dermatol. 2008 Nov;1(4):48-51. PMID: 21218192; PMCID: PMC3016935.
5. Retinoid-Induced Flaring in Patients with Acne Vulgaris: Does It Really Exist?: A discussion of data from clinical studies with a gel formulation of clindamycin phosphate 1.2% and tretinoin 0.025%. J Clin Aesthet Dermatol. 2008 May;1(1):41-3. PMID: 21103310; PMCID: PMC2989803.
6. Deecker A, Graber EM. Over-the-counter Acne Treatments: A Review. J Clin Aesthet Dermatol. 2012 May;5(5):32-40. PMID: 22808307; PMCID: PMC3366450.
7. Leyden J, Stein-Gold L, Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb). 2017 Sep;7(3):293-304. doi: 10.1007/s13555-017-0185-2. Epub 2017 Jun 5. PMID: 28585191; PMCID: PMC5574737.
8. Martin B, Meunier C, Montels D, Watts O. Chemical stability of adapalene and tretinoin when combined with benzoyl peroxide in presence and in absence of visible light and ultraviolet radiation. Br J Dermatol. 1998 Oct;139 Suppl 52:8-11. doi: 10.1046/j.1365-2133.1998.1390s2008.x. PMID: 9990414.