Derm Dispatch: Navigating Benzoyl Peroxide Safety and Acne Treatment Advancements

In this installment of the Derm Dispatch series, Renata Block, DMSc, MMS, PA-C, interviews John Barbieri, MD, MBA, a board-certified dermatologist at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, to discuss current concerns and insights regarding benzoyl peroxide (BPO), particularly its potential to form benzene.

Barbieri explained that benzene formation in BPO products is not due to contamination but rather a chemical instability, especially when exposed to heat. Patients can minimize this risk by storing BPO in cool environments and being cautious about delivery sources, particularly in hot climates. Although benzene is ubiquitous in our environment—from gasoline to pollution—some BPO products have been shown to exceed FDA limits, raising public concern.

“I'm not particularly concerned that people using benzoyl peroxide products are particularly at risk from an absolute risk standpoint...we all take risks in our daily lives,” Barbieri said. “So yes, there may be some very small incremental risk to products that have benzene in them over a long period of time, but that incremental risk seems to be quite small because it's hard to detect.”

Barbieri emphasized that the primary health concern is inhalational exposure, not dermal. Data so far, including his own research, has not shown elevated benzene blood levels or increased cancer risks among BPO users. However, he stresses the importance of reducing benzene presence to zero, as many products already achieve this, likely due to better formulation and manufacturing practices.

From a therapeutic standpoint, BPO remains a crucial acne treatment, especially for moderate-to-severe cases where its antibacterial and antibiotic-resistance-preventing properties are unmatched. Barbieri discourages avoiding BPO entirely, as alternative treatments like oral antibiotics may pose greater risks. He encouraged clinicians to educate patients, evaluate adherence, and reassess diagnoses when BPO seems ineffective. The conversation also explored advancements in dermatology, including new oral IL-23 inhibitors for psoriasis.

“We're getting better treatment responses and less side effects, which is awesome. And I think the more that we can do that using medications that are going to be affordable and accessible, the better it will be for everyone,” Barbieri said.

Barbieri also gave a preview of his current research on spironolactone versus doxycycline in women with acne and app-based cognitive behavioral therapy for psoriasis. He highlights the critical intersection of dermatology and mental health, advocating for broader, more holistic care models. Finally, Barbieri underscored the value of interdisciplinary collaboration, peer education, and ongoing research to ensure both efficacy and safety in dermatologic therapies.