Among topical acne treatments benzoyl peroxide is the most well known treatment which targets prominantly bacterial colonization. This agent is very drying and irritating to the skin especially in high concentrations. It is used to treat different forms of acne lesions, comedonal and non-comedonal, mild to severe forms, alone or in conjunction with other modalities.

Bacteria that normally live on the skin also play a role in acne development. The bacteria known as Propionibacterium acnes majorly and not exclusively is responsible for causing acne. However, all follicular micro-organisms may, under apporpriate highly local conditions, increase or prolong the pathological state in a specific follicle. These bacteria produce substances that cause inflammation,which, in turn, makes work of topical acne treatments more difficult. They also make enzymes, which dissolve the sebum (oil from oil glands in the skin) into irritating substances. These substances also make the inflammation worse. Among topical acne treatments only afew show evident antibacterial effect.

Benzoyl peroxide was probably the first proven effective topical acne modalities. Free-radical oxygen is released upon administration and oxidizes bacterial proteins in sebaceous follicles, decreasing the quantity of irritating free fatty acids and of anaerobic bacteria. It also has keratolytic and comedolytic effects. This agent is most effective for inflammatory adult acne. However, in high concentration may cause inflammation itselt and worsen the situation.

The action of benzoyl peroxide on sebum excretion is questionable. It has been shown that it reduces sebum synthesis. Benzoyl peroxide, however, has a dramatic effect on cutaneous bacteria, reducing by 2 log cylcles the number of skin surface Propionibacterium acnes and Staphylococcus epidermidis so that it must be counted as first line modalities in acne treatment. One study on ductal bacteria confrims that benzoyl peroxide reduces colonization in the duct. This propety renders Benzoyl Peroxide the most effective topical acne modalities. Benzoyl peroxide also may have an anti-inflammatory effect since a reduction in number and size of inflamed lesions is observed early in treatment.

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