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A tube of benzoyl peroxide being squeezed onto a finger for acne prevention

This is How to Use Benzoyl Peroxide
According to a Dermatologist

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Smart advice on incorporating this tried-and-true acne fighter into your skincare routine.

Like Barbra Streisand and Coca Cola Classic, benzoyl peroxide has stood the test of time—there’s a good chance your grandmother even dabbed it on her pimples when she was a teen. And despite all the new treatments and cutting-edge technology out there, it’s still an ingredient dermatologists turn to again and again. Why? That’s simple: It works.

“Benzoyl peroxide is an interesting acne agent because it treats papules and pustules [those red, swollen pimples] as well as blackheads and whiteheads,” says Linda Stein Gold, M.D., a dermatologist in West Bloomfield, Michigan and an Acne Store advisory board member. “It kills bacteria and helps to remove what we call comedones [clogged follicles], and unlike other antibiotics, you never develop a resistance to it,” she says. We put Stein Gold on the spot to find out more about this science-backed acne fighter. 

Q: Benzoyl peroxide is in so many types of products. Does it matter which I use? 

A: Yes, you can get benzoyl peroxide in a lot of forms: There are topical gels that you leave on the skin all day or night and there are benzoyl peroxide washes. Wash is kind of a misnomer here, because if you rinse it off right away, it doesn’t have the contact time it needs to really be effective. So, if you’re going to opt for one, it’s important to leave it on your skin for several minutes. That’s especially true when you’re treating your chest, shoulders, or your back. An off-label tip: I tell my patients to put it on before they hop in the shower. Apply benzoyl peroxide wherever you tend to break out and wait a few minutes before rinsing.   

Q: Benzoyl peroxide comes in different strengths—which should I use?

A: If you’re using a benzoyl peroxide wash, I suggest going with a 10 percent concentration. The studies on benzoyl peroxide washes all used higher strengths. Plus, because you’re going to rinse it off, your skin may better tolerate the higher amount. The strength doesn’t matter as much in leave-on products like benzoyl peroxide gels or creams that you can leave on overnight. The effectiveness has more to do with how the product was formulated and how well the benzoyl peroxide penetrates into the skin, so a 2.5 percent may be just as good as a 5 or 10 percent. Unfortunately, a lot of the brands sold over the counter haven't been formally studied. So start with a lower-strength benzoyl peroxide gel to see if that works first, increasing the strength if necessary.

"Unlike other antibiotics used for acne, we’ve found that people don’t become tolerant to benzoyl peroxide, and it doesn’t stop working."

Q: You don’t develop a resistance to benzoyl peroxide—why is that important?  

A: Unlike other antibiotics used for acne, we’ve found that people don’t become tolerant to benzoyl peroxide, and it doesn’t stop working. That’s good news because you can potentially use it for years and you shouldn’t see a diminishment of its effects.

Q: Can benzoyl peroxide be irritating?

A: Absolutely. And the higher the strength, the more irritation you may experience. A lot of people think they’re allergic to benzoyl peroxide. But one study showed that less than five percent of people have a true allergy to the ingredient. [1] If you react to it—your skin stings or gets red and dry— it’s more likely an irritant reaction than an allergic one.

Q: How do I use benzoyl peroxide and off-set the dryness?

A: Moisturizer, and I like to use a moisturizer at a different time of day. If you apply your benzoyl peroxide gel at night, slather on a good moisturizer in the morning after cleansing. Look for an oil-free formula that says non comedogenic, which means it’s been tested and won’t clog pores.

Q: Can you combine benzoyl peroxide with other acne ingredients?

A: Yes. We mix and match in dermatology all the time. Benzoyl peroxide pairs nicely with treatments like topical retinoids, except tretinoin (the generic form of the acne medication Retin-A). It inactivates it. So, you don’t want to use it at the same time as you do a gel or a wash. The topical retinoid adapalene is a good choice when using benzoyl peroxide for acne. It doesn’t lose its effectiveness, and the two have even been studied together. [2] You can also use an antibiotic and benzoyl peroxide at the same time.

Q: How long should I use benzoyl peroxide on my skin?

A: That’s an important question. To be honest, you should stop treating your acne when it’s gone. And by gone, I mean no more pink or brown spots and no scars. Then switch to maintenance therapy a few times a week in the areas you’re most likely to break out. Pimples start under the skin; you don’t see them until they come to the surface. You want to get in front of your acne, so those lesions never get the chance to erupt.

References:

[1]: https://onlinelibrary.wiley.com/doi/full/10.1002/cia2.12069

[2]: https://pubmed.ncbi.nlm.nih.gov/19746769/

Linda Stein Gold, M.D.

Dr. Linda Stein Gold, Chair of the Acne Store Board of Dermatologists, is the Director of Dermatology Clinical Research and Division Head of Dermatology at the Henry Ford Hospital in Detroit. She received her medical degree from University of Pennsylvania School of Medicine in Philadelphia, completed an internship in the Department of Internal Medicine at the Hospital of the University of Pennsylvania in Philadelphia.

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