Topical benzoyl peroxide for acne.

Area of Science:

• Dermatology
• Pharmacology
• Evidence-Based Medicine

Background:

• Acne vulgaris is a prevalent skin condition with significant economic and psychological impacts.
• Topical benzoyl peroxide (BPO) is a common acne treatment, but its overall efficacy and safety require thorough evaluation.
• Existing research has not definitively established the comparative effectiveness and tolerability of BPO against other treatments.

Purpose of the Study:

• To systematically assess the effects of topical benzoyl peroxide (BPO) for the treatment of acne.
• To evaluate BPO's efficacy and safety, including adverse events and treatment withdrawals, compared to various control and active treatments.

Main Methods:

• A comprehensive search of multiple databases (Cochrane Skin, CENTRAL, MEDLINE, Embase, LILACS) and trial registers was conducted up to February 2019.
• Included were randomized controlled trials (RCTs) comparing topical BPO (alone or in combination) against placebo, no treatment, or other topical medications.
• Primary outcomes included participant self-assessment of acne improvement and withdrawal due to adverse events; adverse event incidence was a key secondary outcome.

Main Results:

• Topical BPO may be more effective than placebo or no treatment for acne improvement (low-certainty evidence).
• Efficacy of BPO appears similar to adapalene and clindamycin, though evidence is of low to very low certainty.
• Withdrawal due to adverse events may be higher with BPO compared to placebo (low-certainty evidence), with common causes including erythema and pruritus. Evidence for increased adverse events with BPO compared to other agents is uncertain or of low certainty.

Conclusions:

• Topical BPO, as monotherapy or add-on, shows potential for acne improvement compared to placebo, with comparable efficacy to adapalene and clindamycin.
• Higher rates of treatment discontinuation with BPO may be linked to tolerability issues rather than severe safety concerns.
• Further high-quality trials are needed to compare different BPO formulations, concentrations, and combination therapies, with standardized reporting of patient-reported outcomes and adverse effects.