Benzoyl peroxide development, pharmacology, formulation and clinical uses in topical fixed-combinations

Benzoyl peroxide (BPO) is a commonly used and highly effective topical treatment for acne that is available in concentrations from 2.5-10%. The compound is not associated with bacterial resistance, and published acne treatment guidelines recommend BPO in conjunction with the long-term use of both topical and systemic antibiotics. A number of combination products containing antibiotics, BPO and/or retinoids are available and useful for tailoring treatment to the needs of each patient over the course of what is often a chronic condition. Fixed combinations of BPO and antibiotics or retinoids address multiple pathogenetic factors by using agents with complementary, but different modes of action. These agents are convenient to use and may improve adherence to therapy by simplifying the regimen for the patient. However, BPO is associated with dose-dependent irritation and dryness. Therefore, formulations containing lower concentrations of BPO (2.5%) minimize irritation, which may improve tolerability and maximize treatment outcomes.