Should I stop my BPO containing products? PART 2
Recent reports of benzene, a known health hazard, in over the counter (OTC) benzoyl peroxide (BPO) products has many acne patients confused and concerned. I’m here to try to help answer your questions. Is it a really big concern? Should I stop my BPO containing products? What can I use in its place?
Exploring this recent concern left me investigating more and more into this issue, so I will divide this article into a few parts over the next few weeks. This is part two of three.
In review, what is Benzoyl Peroxide (BPO) and how is it used? Benzoyl peroxide is commonly used in OTC and some prescription skin care products. It is used to treat acne both by killing acne bacteria, breaking down dead skin that clogs pores, and by working as an anti-inflammatory agent. Many years ago, almost all BPO containing skin care washes moved from prescriptions to OTC. However, topical leave on treatments often contain BPO as well. BPO is often combined with other oral and topical antibiotics for acne because studies have shown that using products in combination reduces the likelihood of developing bacterial resistance.
The most recent reports that triggered the media reports were done by a company called Valisure.
Who is Valisure and what is their role and angle? Pardon me for being suspicious, but this was one of my first questions. According to Wikipedia, the source of all knowledge, “Valisure is an American independent laboratory focused on the testing the purity and safety of pharmaceutical drugs and consumer products. Valisure was founded in 2015 by Adam Clark-Joseph and David Light. After taking an anticonvulsant medication and experiencing negative side effects due to the poor quality of the drug, Clark-Joseph contacted Light about establishing a business testing pharmaceutical products. “
Valisure has unearthed a number of contaminants in common medications in the past including Zantac. Articles in both Consumer Reports and the Wall Street Journal have questioned both Valisures’s method and motive.
How much benzene was in the BPO products? Valisure reportedly tested many OTC BPO containing products by multiple different methods, and their findings were reportedly validated by 3 different labs. The particular testing done in their study looked at the amount of benzene that occurred in the products as part of degradation of the product at higher temperatures. What they found was that at super high temperatures (122 degrees F) for an extended period of time (18 days), a large amount of benzene developed as part of degradation of the product. The amounts that were found in some of the products were 100-1800 ppm (https://www.dermatologytimes.com/view/valisure-s-david-light-unpacks-benzene-findings-stability-testing-and-discourse)
What does this mean for my acne treatment regimen? The degradation of benzoyl peroxide over time is not a new issue, it has been well known for many years since it was FDA approved to treat acne decades ago. In that time, it has become available most commonly in washes and “leave on” topical treatments. Please note that Valisure did not test any prescription products, but we can extrapolate this data to suggest that ALL BPO containing products should be stored at home and during transportation and manufacturing in a cool place. In fact, many of our topical BPO containing RX products recommend refrigeration already. To be the most cautious, discontinue OTC BPO containing products until there is further investigation.
Does Dr Rosenberger recommend BPO containing products? By habit and to avoid bacterial resistance, Dr Rosenberger almost always prescribes a regimen that contains multiple antibacterial ingredients. Most often we prescribe sulfur containing prescription washes in place of OTC BPO washes. However, we do often prescribe prescription topical leave on treatments that contain BPO. It is important to keep these in a cool place, and never in a hot car. To be honest, I think this is common sense.
In part one we learned about benzene, in part three we will discuss what substitutions can be made in an acne regimen if eliminating BPO.
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