The short-term treatment of acne vulgaris with benzoyl peroxide: effects on the surface and follicular cutaneous microflora

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Abstract
A 28-day treatment regimen was undertaken by 12 volunteers, in which 5% (w/v) benzoyl peroxide (BP) in an aqueous gel was applied daily to the entire face. Clinical efficacy of the treatment was assessed after 2, 4, 9, 14 and 28 days, and the surface and follicular microbial populations were enumerated using established techniques. Viable counts were obtained for propionibacteria and Micrococcaceae. Mean numbers of propionibacteria recovered from the skin surface and follicular casts were significantly reduced after 2 days' treatment (Po. The mean non-inflamed lesion count was lower than the pretreatment level at all visits, although the results were variable. The results indicate that significant reductions in surface and follicular microorganisms may be obtained after 48 h treatment with BP. Therefore, the non-specific antibacterial action of BP may be utilized in short intervening courses to reduce the carriage of antibiotic-resistant micro-organisms and thus improve the long-term efficacy of antibiotic acne treatments. The speed of clinical improvement may be limited by the rate at which old lesions disappear, rather than the effectiveness of the treatment in preventing new lesions arising.