Safety Concerns in Acne Treatment: Examining the Risk of Benzoyl Peroxide Products

Announcer:
You’re listening to Clinician’s Roundtable on ReachMD. On this episode, Dr. Linda Stein Gold joins us to discuss the recent safety concerns regarding benzoyl peroxide products for acne treatment. Dr. Stein Gold is the Director of Dermatology Clinical Research at Henry Ford Health System in Detroit as well as the Division Head of Dermatology at Henry Ford Health System in West Bloomfield, Michigan. Let’s hear from her now.

Dr. Stein Gold:
Benzoyl peroxide has been a really hot topic, and it’s been a hot topic for about the past year. Last year at the AAD, we found that there was a report that was submitted from an independent laboratory called Valisure that found that benzoyl peroxide products were emitting benzene at high temperatures, and these were concentrations that were much higher than the FDA deemed safe. And I wasn’t that worried about this because I don’t have my patients put benzoyl peroxide in the oven; I don’t worry about it sitting in a hot car. But more recently, there was another study that was done, and this study looked at the levels of benzene in unopened products at room temperature, and so this caught my attention quite a bit more. This study also asks the question, “What about the encapsulated benzoyl peroxide?” There’s a silicone-encapsulated formulation. Does this do better? It also looked at what happens when benzoyl peroxide is exposed to UV light. And in this study, they found that even at room temperature, there were products that were emitting benzene at higher levels than are appropriate. And what they found was if you keep the products refrigerated, it significantly minimizes that breakdown. They also found, unfortunately, that the encapsulated benzoyl peroxide didn’t reduce the amount of benzene that was released except, again, when it was kept in refrigeration. And we do see some benzene formulation when benzoyl peroxide is exposed to UV light.

So I think that was interesting, but we have a lot of studies that have really gone after this and tried to study much more carefully if there is actually an association between the use of benzoyl peroxide and the actual development of cancer. And there have been several studies at this point that have looked at acne patients who use benzoyl peroxide compared to acne patients who don’t use it and acne patients in general, and it looked at the levels of benzoyl peroxide, including acute myeloid leukemia, which seems to be the one that’s most heavily associated with benzene, and also other cancers. And it seems that we haven’t really seen good evidence that there’s an increase in cancers that have developed.

But one of the really important papers that came out said, “Well, is there a difference, for instance, in the formulation of benzoyl peroxide?” And I thought this was interesting because it turns out the benzoyl peroxide washes seem to break down into benzene much more frequently than the leave-on gels do, so I’ve started to say, “Well, maybe I’m just going to prescribe the leave-on gels.” If the benzoyl peroxides have antioxidants in them or benzoic acid, it also seems to be better in the sense that it breaks down benzene much less. So bottom line, I’ve been telling my patients, “Keep the benzoyl peroxide in the refrigerator, use it when needed, and don’t leave it in a hot car.” I ask them to throw it out around the expiration date and don’t use it for long periods of time, and I’ve started writing for gels as opposed to washes. 

And finally, just recently, we found that the FDA has looked into this a little bit more closely, and some companies have now voluntarily removed some of their benzoyl peroxide products. There are six over-the-counter products that have been removed from the shelves.

Announcer:
That was Dr. Linda Stein Gold discussing the potential risk of benzoyl peroxide products for acne treatment. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!