Allergic Contact Dermatitis Due to Benzoyl Peroxide From an Unlikely Source

Adelman, Madeline, BS*; Mohammad, Tasneem, MD†; Kerr, Holly, MD†

Dermatitis: May/June 2019 - Volume 30 - Issue 3 - p 230–231

doi: 10.1097/DER.0000000000000470

PEARLS & ZEBRAS

Benzoyl peroxide is effective for reducing the number and severity of acne lesions. It has a bactericidal effect on Cutibacterium acnes bacteria associated with acne and does not induce antibiotic resistance.[11][12] It may be combined with salicylic acid, sulfur, erythromycin or clindamycin (antibiotics), or adapalene (a synthetic retinoid). Two common combination drugs include benzoyl peroxide/clindamycin and adapalene/benzoyl peroxide, an unusual formulation considering most retinoids are deactivated by peroxides. Combination products such as benzoyl peroxide/clindamycin and benzoyl peroxide/salicylic acid appear to be slightly more effective than benzoyl peroxide alone for the treatment of acne lesions.[12]

Benzoyl peroxide for acne treatment is typically applied to the affected areas in gel, cream, or liquid, in concentrations of 2.5% increasing through 5.0%, and up to 10%.[11] No strong evidence supports the idea that higher concentrations of benzoyl peroxide are more effective than lower concentrations.[11]

Benzoyl peroxide commonly causes initial dryness and sometimes irritation, although the skin develops tolerance after a week or so. A small percentage of people are much more sensitive to it and liable to suffer burning, itching, crusting, and possibly swelling.[13] Applying the lowest concentration and building up as appropriate is most logical. Once tolerance is achieved, increasing the quantity or concentration and gaining tolerance at a higher level may give better subsequent acne clearance.[14] Irritation can also be reduced by avoiding harsh facial cleansers and wearing sunscreen prior to sun exposure.[14]

Other uses

Other common uses for benzoyl peroxide include:

Bleaching hair

Tooth whitening systems

The preparation of bleached flour

As a convenient oxidant in organic chemistry

An initiator and catalyst for polyester thermoset resins, as an alternative to the much more hazardous methyl ethyl ketone peroxide[citation needed]

A hardener to start the polymerization process in resins, for instance, PMMA resins can be polymerized with benzoyl peroxide.[15]

Removing ink and dye stains on vinyl dolls and other playscale figures.[16]

In the U.S., the typical concentration for benzoyl peroxide is 2.5% to 10% for both prescription and over-the-counter drug preparations that are used in treatment for acne. Higher concentrations are used for hair bleach and teeth whitening. Benzoyl peroxide, like most peroxides, is a powerful bleaching agent. Contact with fabrics or hair can cause permanent color dampening almost immediately. Even secondary contact can cause bleaching; for example, contact with a towel that has been used to wash off benzoyl peroxide-containing hygiene products.[17] Benzoyl peroxide is also used as a radical initiator to induce chain-growth polymerization reactions,[18] and is the most important among the various organic peroxides used for this purpose.[19]

,