Acne and Rosacea Charity Training Manual

Inflammatory acne
In mild to moderate acne, start with topical agents which can be very effective. In all patients apart from those with mild acne, always combine treatment
with a topical retinoid or other anti-comedonal treatment.
Topical treatment for inflammatory acne
Benzoyl peroxide
Benzoyl peroxide is used commercially to bleach flour. When applied to the skin it will enter the hair follicle and release oxygen. This is toxic
to the anaerobic bacteria living in the follicle including P acnes and kills them. It is a very effective treatment for inflammatory acne and the
bacteria cannot develop resistance to it.
Benzoyl peroxide is available in a number of different formulations from 2.5% to 10% in creams, gels and washes. It can be applied in the
morning to affected areas. It is very effective but does have a number of problems:
1. It is a bleaching agent and will bleach clothes, towels and bedding. Warn patients of this and advise to use white towels and white
pillowcases. If used on the trunk, white T-shirts
2. Benzoyl peroxide can be very drying and irritating. Some patients can only tolerate the lower concentrations. Advise care when using
benzoyl peroxide washes as they may make the skin too sensitive to use topical retinoids or other topical products.
3. Benzoyl peroxide is a sensitizer and patients may become allergic to it. Tell patients to use to a test area for a few days before using it
all over.
Benzoyl peroxide is also available in combination with adaplene (marketed as Epiduo, 0.1% adapalene with 3% benzoyl peroxide), targeting
inflammatory and non-inflammatory lesions at the same time.
A number of the benzoyl peroxide products came off the shelves due to manufacturing problems. Thankfully, they are now available on
prescription and over the counter.