Hydrogen peroxide and cutaneous biology: Translational applications, benefits, and risks

Hydrogen peroxide (H₂O₂) is an endogenous reactive oxygen species that contributes to oxidative stress directly as a molecular oxidant and indirectly through free radical generation. Topically applied 1% to 45% H₂O₂ can be used for a range of clinical purposes, which will be reviewed here in addition to its safety. In concentrations from 1% to 6%, H₂O₂ has antimicrobial properties and can act as a debriding agent through its effervescence, making low-concentration H₂O₂ useful for wound care. H₂O₂ has also been shown to promote venous insufficiency ulcer healing, but studies in other wound types are needed. In 1% formulations, H₂O₂ is used outside the United States to treat acne and has shown efficacy similar to or greater than benzoyl peroxide, with reduced side effects. In a concentration of 40%, H₂O₂ is US Food and Drug Administration-approved to treat seborrheic keratoses and may cause fewer pigmentary changes than cryotherapy, although elimination often requires 2 to 4 treatments. However, H₂O₂ should be used with caution, as exposure can cause adverse effects through its oxidant capabilities. Low H₂O₂ concentrations cause only transient symptoms (blanching and blistering), but exposure to 9% to 45% H₂O₂ can cause more severe skin damage, including epidermal necrosis leading to erythema and bullae. Overall, H₂O₂ has numerous therapeutic uses, and novel indications, such as treating actinic keratoses and skin cancers, continue to be explored.