Acne: Trouble Over the Counter - Benzoyl Peroxide Banned by European Union
There are many over the counter (OTC) preparations for treatment
of acne. Sold as lotions, gels, creams, and cleansers, OTC
products can be a precarious buy and consumers should be aware
that chemicals applied to the skin can also be absorbed into the
body. The potential adverse effects of chemical agents make
natural skin care products seem more attractive.
This is especially true for skin conditions such as acne and
rosacea as harsh chemicals may only worsen matters. Synthetic
chemicals can induce unnecessary inflammation beyond the
confines of the sebaceous glands resulting in acne scars.
Additionally, some chemicals can even be absorbed into the skin
and have varying levels of systemic toxicity.
Benzoyl peroxide, the first topical agent for acne vulgaris,
remains the most widely used OTC acne treatment in the United
States. It is inexpensive to manufacture and widely marketed.
Benzoyl peroxide dissolves comedons and has bactericidal effect
by oxidizing proteins of the offending microbe, P. acne (Leyden,
1997). Though it may be effective for mild acne, benzoyl
peroxide is not free from adverse effects according to the
European Commission.
The most common adverse effect is extreme dryness of skin. It
can also causes irritation, stinging, burning and peeling of
skin. A formulation containing 2.5% benzoyl peroxide was found
to have less burning and peeling of skin as compared with 5% or
10% benzoyl peroxide (Mills et al. 1986). Allergic contact
dermatitis was found in 1-2% patients using benzoyl peroxide
(Ives, 1992). It can cause bleaching of hair and clothing.
Temporary skin discoloration may occur if benzoyl peroxide is
used with sunscreen containing para-amino benzoic acid (PABA).
Similarly concomitant use of benzoyl peroxide with tretinoin can
lead to severe irritation of skin. Benzoyl peroxide should not
be used in pregnancy as its safety during pregnancy is not
documented. The safety in breast-feeding women and children is
also not established.
In animal studies, it was has found to induce skin cancer after
1 year of use (Kraus et al. 1995). Long-term studies are needed
to profile its adverse effect in humans. Benzoyl peroxide has
been banned for use in cosmetics by the European Union. OTC Acne
treatments that contain benzoyl peroxide are included in this
ban throughout Europe. Acne preparations made of benzoyl
peroxide may contain various other chemical ingredients.
Glycolic acid is a photo sensitizer and may be toxic to
gastrointestinal system, nervous system and kidneys.
Triethanolamine can form carcinogenic nitrosamine compounds on
the skin or in the body after absorption. It may also elicit
immune reaction in form of allergic dermatitis or asthmatic
attacks. Diisopropanolamine may release carcinogenic nitrosamine
compounds.
While, benzoyl peroxide can be used for short-term treatment of
mild acne in the US, its long-term use has the potential to
damage skin. On the whole, safer options that allow natural
resolution of acne are recommended. Natural alternatives to
benzoyl peroxide are calendula or tea tree oil (Bassett et al.
1990). Psidium guajava and Juglans regia leaf extracts were
found to be beneficial in treating acne (Qadan et al. 2005).
Granulysin peptides were also found to be effective against P.
acne and may form an alternative therapy against acne in future
(McInturff et al. 2005).
If acne are severe and not amenable to benzoyl peroxide
treatment, one should consult a dermatologist for prescription
drugs like topical retinoids (Tretinoin, Adapalene and
Tazarotene), topical antibiotics (clindamycin, erythromycin),
oral isotretinoin, oral antibiotics (doxycycline, minocycline).
References: 1. Leyden JJ (1997) Therapy for acne vulgaris. New
England Journal of Medicine 336, 1156-62. 2. Ives TJ (1992)
Benzoyl peroxide, Am Pharm NS32 (8), 33-8. 3. Kraus AL, Munro
IC, Orr JC, Binder RL, LeBoeuf RA, Williams GM (1995) Benzoyl
peroxide: an integrated human safety assessment for
carcinogenicity, Regul Toxicol Pharmacol 21, 87-107. 4. Mills OH
Jr, Kligman AM, Pochi P, Comite H (1986) Comparing 2.5%, 5%, and
10% benzoyl peroxide on inflammatory acne vulgaris, Int J
Dermatol 25, 664-7. 5. Bassett IB, Pannowitz DL, Barnetson RS
(1990) A comparative study of tea-tree oil versus
benzoylperoxide in the treatment of acne. Med J Aust, 153:
455-8. 6. Qadan F, Thewaini AJ, Ali DA, Afifi R, Elkhawad A,
Matalka KZ (2005) The antimicrobial activities of Psidium
guajava and Juglans regia leaf extracts to acne-developing
organisms. Am J Chin Med 33,197-204. 7. McInturff JE, Wang SJ,
Machleidt T, Lin TR, Oren A, Hertz CJ, Krutzik SR, Hart S, Zeh
K, Anderson DH, Gallo RL, Modlin RL, Kim J (2005)
Granulysin-derived peptides demonstrate antimicrobial and
anti-inflammatory effects against Propionibacterium acnes. J
Invest Dermatol 125, 256-63.
About the author:
James Dalton is a freelance writer specializing in skin
conditions including acne, rosacea, and eczema. Visit
http://www.AcneResearchLabs.com for more information
regarding natural skin care solutions including effective acne
treatment and rosacea treatment for sensitive skin.
James Dalton
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