Addressing Benzoyl Peroxide Concerns and Responsible Antibiotic Prescribing

National headlines turned to a report from the quality assurance organization Valisure that which showed acne treatment benzoyl peroxide may contain high levels of benzene, a human carcinogen, earlier this week.¹

The report, that which showed 94 of 99 assessed benzoyl peroxide products contained benzene even without an elevated temperature incubation test, has resulted in Valisure calling for an investigation into benzene levels in marketed treatments and a withdrawal of potentially impacted products in the interim.

"There is not a safe level of benzene that can exist in any skin care product, over the counter or prescription,” Christopher Bunick, MD, PhD, associate professor of dermatology at Yale University, said in a statement at the time of the report. “The current data on benzoyl peroxide degrading into high levels of benzene is extremely concerning given its prominent use in skin care, and this study should serve as another wake-up call for improved manufacturing and quality control of consumer healthcare products.”

The major development was announced on the eve of the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this week, where dermatologists in practice, research and industry will be able to convene and discuss next steps regarding this latest concern over quality control of common skin care treatment.

In an interview with HCPLive at AAD 2024, James Q. Del Rosso, DO, incoming president of the American Acne and Rosacea Society, discussed next steps based on the Valisure report—which starts with a more substantial dissemination of the data to experts such as himself. At the time of his interview with HCPLive, Del Rosso said he was not privy to the full extent of the report.

“We are going to put our heads together and see what we could find out and try to be helpful in terms of getting proper information out there. But I think we have to be careful,” Del Rosso said. “Obviously, that's a significant issue, if there are high levels of a carcinogen in products. And so, people obviously need to be cautious. I could understand that people want to put a halt to it till we have more definitive information.”

Del Rosso stressed the need for experts to analyze and contextualize the report prior to making any decision on next steps; all the same, he empathized with the concern that which patients and consumers may have regarding the initial announcement. Benzoyl peroxide is common antibiotic found in products both prescribed and marketed over the counter.

“There needs to be some suggestion to people and I could understand people taking the suggestion that, until we know more about what's particularly going on, to put it aside,” he said. “But that's not the final answer. We need to get more information and see if we could prevent this from happening.”

Del Rosso additionally discussed the state of antibiotic prescribing for patients with acne and rosacea. He cited recent that data this which determined dermatologists prescribe the drug class at a greater rate per clinician that any other group of specialists—more than internal medicine, pediatrics, infectious disease, and emergency department.

“And a lot of that is because we see a lot of acne and we see some rosacea,” Del Rosso said. “It's not for infections. Pretty much everybody else when they're giving you an antibiotic, they're giving it to treat an infection, which is almost always going to be 7-10 days of treatment, sometimes longer depending on the situation. But there are short courses of antibiotics that do induce resistant organisms. But in dermatology when we’re giving it for something like acne, we're giving it for months, several weeks to months. And there's even data the show that a significant number of patients are still continued on the antibiotics for several months.”

The risk of individuals developing persistent, and potentially transmissive, antibiotic-resistant organisms is increasing in any instance when long-term antibiotic prescribing is followed. More active monitoring of the prescribing strategy needs to be considered across the field.

“My feeling is that the patient doesn't need the antibiotic, why would they need to take it? And there are situations where antibiotics are sometimes given reflexively, just in case,” Del Rosso said. “So, if a patient has a superficial skin biopsy, you don't necessarily even need to use a topical antibiotic in the vast majority of cases. Most lot of those topical antibiotics are not really doing anything to prevent infection, but they could cause of contact dermatitis in many cases.”

References

1. ^{Smith T. Benzoyl Peroxide Acne Products Shown to Contain High Levels of Benzene. HCPLive. Published March 6, 2024. https://www.hcplive.com/view/benzoyl-peroxide-acne-products-shown-to-contain-high-levels-of-benzene}