American Journal of Clinical Dermatology

, Volume 5, Issue 4, pp 261–265 | Cite as

Benzoyl Peroxide-Based Combination Therapies for Acne Vulgaris

A Comparative Review
  • Gina A. Taylor
  • Alan R. Shalita
Review Article


Benzoyl peroxide, with its broad-spectrum antimicrobial activity, is among the most widely used topical agents in the treatment of inflammatory acne vulgaris. Benzoyl peroxide is marketed either alone or in combination with other topical antibiotics; namely, erythromycin and clindamycin. The combination products confer specific advantages over benzoyl peroxide alone, particularly in decreasing the in vivo follicular counts of Propionibacterium acnes, the anaerobic bacterium implicated in the pathogenesis of acne. In addition, the topical treatment of inflammatory acne has been complicated by the development of P acnes resistance to topical erythromycin and clindamycin. Combination products containing benzoyl peroxide and the topical antibiotics have been shown to both: (i) prevent the development of antibiotic resistance in acne patients; and (ii) confer significant clinical improvement to patients who have already developed antibiotic resistance.


Acne Clindamycin Benzoyl Peroxide Combination Product Topical Antibiotic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Taylor has no financial interest or relevant conflicts of interest in this review. Dr Shalita is a consultant for Dermik and Stiefel Laboratories. His department has received research grants from both companies.


  1. 1.
    Oberemok SS, Shalita AR. Acne vulgaris, II: treatment. Cutis 2002 Aug; 70 (2): 111–4PubMedGoogle Scholar
  2. 2.
    Thiboutot D. Acne: 1991–2001. J Am Acad Dermatol 2002 Jul; 47 (1): 109–17PubMedCrossRefGoogle Scholar
  3. 3.
    Leyden JJ, Shalita AR. Rational therapy for acne vulgaris: an update on topical treatment. J Am Acad Dermatol 1986; 15 (4 Pt 2): 907–15PubMedCrossRefGoogle Scholar
  4. 4.
    Kligman AM, Leyden JJ, Stewart R. New uses for benzoyl peroxide: a broad-spectrum antimicrobial agent. Int J Dermatol 1977 Jun; 16 (5): 413–7PubMedCrossRefGoogle Scholar
  5. 5.
    Smith EB, Padilla RS, McCabe JM, et al. Benzoyl peroxide lotion (20 percent) in acne. Cutis 1980 Jan; 25 (1): 90–2PubMedGoogle Scholar
  6. 6.
    Seubert S, Seubert A. Penetration of benzoyl peroxide into the skin [in German]. Hautarzt 1984 Sep; 35 (9): 455–8PubMedGoogle Scholar
  7. 7.
    JGoldstein JA, Pochi PE. Failure of benzoyl peroxide to decrease sebaceous gland secretion in acne. Dermatologica 1981; 162 (4): 287–91PubMedCrossRefGoogle Scholar
  8. 8.
    Fanta D, Muller MM. Effect of benzoyl peroxide on skin surface lipids. Dermatologica 1979; 158 (1): 55–9PubMedCrossRefGoogle Scholar
  9. 9.
    Burkhart OG, Butcher O, Burkhart ON, et al. Effects of benzoyl peroxide on lipogenesis in sebaceous glands using an animal model. J Cutan Med Surg 2000 Jul; 4 (3): 138–41PubMedGoogle Scholar
  10. 10.
    Mills Jr OH, Kligman AM, Pochi P, et al. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol 1986 Dec; 25 (10): 664–7PubMedCrossRefGoogle Scholar
  11. 11.
    Mesquita-Guimaraes J, Ramos S, Tavares MR, et al. A double-blind clinical trial with a lotion containing 5% benzoyl peroxide and 2% miconazole in patients with acne vulgaris. Clin Exp Dermatol 1989 Sep; 14 (5): 357–60PubMedCrossRefGoogle Scholar
  12. 12.
    Reinel D, Beierdorfer H. A new drug combination for the topical treatment of acne. Miconazole 2% + benzoyl peroxide 5% versus benzoyl peroxide 5%: a double-blind study [in German]. Z Hautkr 1985 Apr 15; 60 (8): 648–50, 653–6PubMedGoogle Scholar
  13. 13.
    Borglund E, Kristensen B, Larsson-Stymne B, et al. Topical meclocycline sulfosalicylate, benzoyl peroxide, and a combination of the two in the treatment of acne vulgaris. Acta Derm Venereol 1991; 71 (2): 175–8PubMedGoogle Scholar
  14. 14.
    Goulden V. Guidelines for the management of acne vulgaris in adolescents. Paediatr Drugs 2003; 5 (5): 301–13PubMedGoogle Scholar
  15. 15.
    Burkhart ON, Specht K, Neckers D. Synergistic activity of benzoyl peroxide and erythromycin. Skin Pharmacol Appl Skin Physiol 2000 Sep-Oct; 13 (5): 292–6PubMedGoogle Scholar
  16. 16.
    Burke B, Eady EA, Cunliffe WJ. Benzoyl peroxide versus topical erythromycin in the treatment of acne vulgaris. Br Dermatol 1983 Feb; 108 (2): 199–204CrossRefGoogle Scholar
  17. 17.
    Chalker DK, Shalita AR, Smith JG, et al. A double-blind study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vulgaris. J Am Acad Dermatol 1983 Dec; 9 (6): 933–6PubMedCrossRefGoogle Scholar
  18. 18.
    Gupta AK, Lynde CW, Kunynetz RA, et al. A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4% in the treatment of moderate acne vulgaris of the face. J Cutan Med Surg 2003 Jan-Feb; 7 (1): 31–7PubMedCrossRefGoogle Scholar
  19. 19.
    Harkaway KS, McGinley KJ, Foglia AN, et al. Antibiotic resistance patterns in coagulase-negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy. Br J Dermatol 1992 Jun; 126 (6): 586–90PubMedCrossRefGoogle Scholar
  20. 20.
    Eady EA, Farmery MR, Ross JI, et al. Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and -resistant skin bacteria from acne patients. Br J Dermatol 1994 Sep; 131 (3): 331–6PubMedCrossRefGoogle Scholar
  21. 21.
    Thiboutot D, Jarratt M, Rich P, et al. A randomized, parallel, vehicle-controlled comparison of two erythromycin/benzoyl peroxide preparations for acne vulgaris. Clin Ther 2002 May; 24 (5): 773–85PubMedCrossRefGoogle Scholar
  22. 22.
    Swinyer U, Baker MD, Swinyer TA, et al. A comparative study of benzoyl peroxide and clindamycin phosphate for treating acne vulgaris. Br J Dermatol 1988 Nov; 119 (5): 615–22PubMedCrossRefGoogle Scholar
  23. 23.
    Leyden J, Kaidbury K, Levy SF. The combination formulation of clindamycin 1% plus benzoyl peroxide 5% versus 3 different formulations of topical clindamycin alone in the reduction of Propionibacterium acnes: an in vivo comparative study. Am J Clin Dermatol 2001; 2 (4): 263–6PubMedCrossRefGoogle Scholar
  24. 24.
    Leyden JJ, Berger RS, Dunlap FE, et al. Comparison of the efficacy and safety of a combination topical gel formulation of benzoyl peroxide and clindamycin with benzoyl peroxide, clindamycin and vehicle gel in the treatments of acne vulgaris. Am J Clin Dermatol 2001; 2 (1): 33–9PubMedCrossRefGoogle Scholar
  25. 25.
    Parry MF, Rha CK. Pseudomembranous colitis caused by topical clindamycin phosphate. Arch Dermatol 1986 May; 122 (5): 583–4PubMedCrossRefGoogle Scholar
  26. 26.
    Milstone EB, McDonald AJ, Scholhamer Jr CF. Pseudomembranous colitis after topical application of clindamycin. Arch Dermatol 1981 Mar; 117 (3): 154–5PubMedCrossRefGoogle Scholar
  27. 27.
    Leyden JJ, Hickman JG, Jarratt MT, et al. The efficacy and safety of a combination benzoyl peroxide/clindamycin topical gel compared with benzoyl peroxide alone and a benzoyl peroxide/erythromycin combination product. J Cutan Med Surg 2001 Jan-Feb; 5 (1): 37–42PubMedGoogle Scholar
  28. 28.
    Ellis ON, Leyden J, Katz HI, et al. Therapeutic studies with a new combination benzoyl peroxide/clindamycin topical gel in acne vulgaris. Cutis 2001 Feb; 67 (2 Suppl.): 13–20PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Department of DermatologySUNY Downstate Medical CenterBrooklynUSA

Personalised recommendations