Acne Medication in the News

There are two popular ingredients used in over the counter acne products: one a synthetic chemical, and the other natural. The synthetic ingredient is linked to cancer.

Acne vulgaris is an inflammatory skin disease affecting around 85% of people between the ages of 12 and 24, though it can also last into older ages.

Yesterday, an alarming report was released concerning the presence of a carcinogenic (cancer causing) chemical found in many popular over-the-counter (OTC) topical medications for the treatment of acne. In today’s post, I break down the science behind this alarming report and share what I’ve done in response in my own household.

There are a number of different topical and oral medications used to manage the inflammatory skin disease of acne. Among OTC topicals, two of the most popular agents incorporated into soaps and creams are salicylic acid (from the willow tree) or the synthetic molecule, benzoyl peroxide (BPO), which was first synthesized by a German scientist in 1858.

In addition to its applications in topical skin remedies for acne, BPO has a number of other industrial applications including in the production of plastics and as a bleaching agent.

When it comes to acne treatment, BPO is used alone or in combination with other acne therapies such as salicylic acid, retinoids, or certain antibiotics. It is an an important ingredient in the dermatological toolkit for the management of acne.

Chemical structures of common topical acne medication ingredients. New concerns have arisen over studies that show benzoyl peroxide (BPO) breaks down into benzene under heat, creating high levels of this cancer-causing benzene in the acne product.

Why the reason for alarm over BPO?

Yesterday, the news broke in that high levels of benzene—a molecule that causes cancer—was found in numerous BPO acne products. Sample headlines:

• Dermatology Times. “BREAKING NEWS: Benzene Found in Various Acne Products; Valisure Files Petition With FDA to Recall Treatments”

• Reuters. “Cancer-causing chemical found in Clinique, Clearasil acne treatments, U.S. lab reports”

• Bloomberg. “Chemical Linked to Cancer Found in Acne Creams Including Proactiv, Clearasil”

The report came from the independent testing lab, Valisure LLC, which filed a petition with the FDA to investigate and to recall these treatments until an investigation has been conducted. Importantly, the FDA has not yet investigated or rendered a decision.

What were the major findings in the report?

Valisure tested 66 BPO-containing products, including various formulations such as washes, gels, creams, and lotions. Benzene is a very unsafe molecule and the current FDA guidelines only allow for up to 2 parts per million (ppm) of benzene in products. Instead, Valisure found products with 12 times more than the allowable limit. For products subjected to heat (such as the temperature of a medicine left in a hot car), they found products containing from 114 to 1761 ppm—that is 57X to 880X the allowable limit!

BPO is highly reactive under some environmental conditions, such as heat. Here is a chemical explanation of how BPO breaks down into benzoic acid and benzene from the Valisure FDA petition. Source.

While most of us would not store our medicine under conditions of long-term heat exposure, we also don’t have control over how products may be handled before they reach store shelves. The benzene here is not an additional contaminant introduced to the medicine, but rather a byproduct of the breakdown of the BPO ingredient. Thus, this affects all products containing BPO.

What to do?

While I am not a physician and cannot give medical advice, I am a mother of teens with acne and can share what I have done in response to these findings. For now, I’ve removed all BPO containing products from our medicine cabinet. Remember, some products don’t just contain BPO, but may also be formulated in combination with other acne drugs. Here is a list of some of the affected products, but is not comprehensive. Read your labels carefully if you wish to remove BPO from your medicine cabinet:

• Proactiv 2.5% BPO cream

• Up & Up 2.5% BPO Cream

• Walgreens 10% BPO bar

• Harris 10% BPO wash

• Clinique 2.5% BPO cream

• Clearasil 10% BPO cream

• La Roche-Posay 5.5% BPO cream

• PanOxyl 10% BPO cream

• Sandra Lee MD 2.5% BPO lotion

• Oxy 10% BPO cream

• Galderma 5% BPO cream

• Equate 10% BPO cream

• Differin 5% BPO cream

• CeraVe 4% BPO cream

• Sandoz 5% BPO gel

• TARO 2.5% BPO gel

• Neutrogena 10% BPO gel

The Takeaway

While BPO has been an important medicine in the fight against acne, we luckily have other safe options to explore for management of this inflammatory skin condition. Talk to your pediatrician, primary care doctor, or dermatologist to determine the best treatment regimen for you or your child.

Yours in health, Dr. Quave

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Cassandra L. Quave, Ph.D. is a scientist, author, speaker, podcast host, wife, mother, explorer, and professor at Emory University School of Medicine. She teaches college courses and leads a group of research scientists studying medicinal plants to find new life-saving drugs from nature. She hosts the Foodie Pharmacology podcast and writes the Nature’s Pharmacy newsletter to share the science behind natural medicines. To support her effort, consider a paid or founding subscription, with founding members receiving an autographed 1st edition hardcover copy of her book, The Plant Hunter.

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