My Issue with Benzoyl Peroxide, & Why I Will Continue to Use & Recommend It to Clients
This article discusses what benzoyl peroxide is, how it works, and addresses concerns regarding it, such as whether it accelerates skin aging or disrupts the skin's microbiome, along with the potential consequences of these effects.
What is benzoyl peroxide?
Benzoyl peroxide (BPO) is used to treat acne by acting as an antiseptic to decrease the number of bacteria on the skin's surface. It is arguably the best acne-fighting ingredient on the market and acts like a medicine for acne.
How does benzoyl peroxide work?
When applied to the skin, benzoyl peroxide penetrates the pores, releasing oxygen compounds and benzoic acid that target and kill acne-causing bacteria while disrupting their cell membranes. Additionally, BPO has anti-inflammatory properties that can help reduce acne. Bacteria does not become resistant to benzoyl peroxide.
My two issues with benzoyl peroxide (one former, one present):
BPO accelerates skin aging due to the free radical formation created when using the ingredient.
BPO disrupts the skin's microbiome, meaning it kills "good" and "bad" bacteria. This dybiosis can potentially lead to accelerated aging and other unknown consequences.
Does benzoyl peroxide accelerate skin aging?
Free radicals are unstable molecules produced during normal cell metabolism, which is crucial for energy production and cell maintenance. Their instability arises from having an unpaired electron. Although free radicals can help combat pathogens and fight infections when functioning correctly, an excess of them leads to oxidative stress as they steal electrons from other molecules, resulting in cellular damage. Antioxidants counteract free radicals by donating electrons, thereby stabilizing them. When free radicals accumulate, they can harm various molecules, including DNA, lipids, and proteins.
Free radicals also can come from external sources like UV rays from the sun, pollution, and infrared radiation. These are examples of free radicals we come in contact with daily from our environment.
Benzoyl peroxide creates free radicals called benzoyloxyl radicals, which convert into phenyl radicals. When benzoyl peroxide is applied to the skin, the damage that occurs from phenyl radicals is brief and is easily counteracted by following benzoyl peroxide with antioxidant-rich products.
The free radicals generated by benzoyl peroxide are so fleeting and reactive that combining BPO with an antioxidant-rich product can diminish the effectiveness of BPO. Therefore, it's best to apply an antioxidant product a few minutes after applying BPO.
It has been proven in studies that BPO does reduce some antioxidants on the skin such as vitamin E and glutathione by as much as 50%. These antioxidants can be easily replenished by following BPO with an antioxidant-rich product.
It can be argued that benzoyl peroxide may delay aging due to its anti-inflammatory nature. From personal observation, estheticians who have used benzoyl peroxide consistently for years do not appear more aged than those who have not used it. Benzoyl peroxide has been a common acne treatment for more than 60 years.
Does benzoyl peroxide disrupt the skin's microbiome?
Benzoyl peroxide reduces the diversity of the skin's microbiome by targeting and killing bacteria, particularly the acne-causing Cutibacterium acnes. The skin hosts approximately a thousand bacterial species, including Cutibacterium acnes, Staphylococcus epidermidis, Staphylococcus aureus, and Corynebacterium. One study indicated that benzoyl peroxide decreases the population of Cutibacterium acnes while increasing the population of Staphylococcus.
I have some questions...
One could argue that a cause of acne is dysbiosis of the skin microbiome, so does using benzoyl peroxide and further disrupting the microbiome have significant negative consequences?
Furthermore, do the benefits of benzoyl peroxide outweigh the risks associated with dysbiosis?
If benzoyl peroxide does cause significant dysbiosis, how long would it take to restore the microbiome?
Furthermore, how do we establish a "healthy" skin microbiome, and what does it look like?
Research on the skin microbiome is still evolving, and significant developments are expected in the coming years.
Perhaps using a true probiotic skincare line would be a good alternative to benzoyl peroxide if one would subscribe to the theory that BPO is very harmful to the skin's microbiome. While such lines are available, some reviews indicate that they might actually worsen acne. The reason for this can be multifaceted and may not be because the probiotic skincare doesn't work at decreasing acne, plain and simple. It also seems that effectively using these probiotic lines may require stopping benzoyl peroxide. Given that benzoyl peroxide is already a well-established and effective acne treatment, is it worth investing time and money in exploring these new and currently less proven alternatives?
I believe the future of skincare involves understanding the skin's microbiome better and being able to identify which species of bacteria we may be lacking and the consequences. In addition, I think the development of microbiome supporting, probiotic lines that are approachable and easily understood is around the corner.
Why will I continue to use and recommend benzoyl peroxide?
Benzoyl peroxide is undeniably the most effective acne-fighting ingredient available. While other ingredients like sulfur, salicylic acid, mandelic acid, and retinoic acid also offer amazing acne treatment benefits, benzoyl peroxide stands out due to its exceptional ability to heal and prevent breakouts. It works even better when combined with other ingredients tailored to your unique skin type and needs.
Skin microbiome diversity is a relatively new area of study. Some may criticize benzoyl peroxide for potentially harming the skin's microbiome, but there is not enough research to prove this nor are there enough alternatives for BPO available. In addition, BPO has been in use long enough for many people to show that long-term use does not significantly impact aging.
Until more information becomes available about skin microbiome diversity and we have effective alternatives like probiotic skincare options, I will continue to use and recommend benzoyl peroxide to my clients. It is a transformative ingredient in an acne-clearing journey that can significantly improve peoples' skin and confidence. I'm sure it's not going anywhere anytime soon.
