Benzoyl Peroxide Side Effects

Many people with acne have a love-hate relationship with benzoyl peroxide (BP)—love the results but hate the side effects. The good news is, benzoyl peroxide is one of the most effective acne treatments available, and some of its effects can be managed by knowing what to expect.

Some people can't tolerate benzoyl peroxide, no matter how carefully they use it. If this is the case for you, don't worry. There are benzoyl peroxide-free treatment options that may work better for you.

This article covers the side effects of benzoyl peroxide, when to see a healthcare provider, and alternative acne medications to consider.

Common Side Effects

In addition to your desired effect of diminishing acne, benzoyl peroxide can lead to other side effects that are less desirable.

Dry Skin

Nearly every acne treatment causes some amount of dryness. The higher the percentage of the benzoyl peroxide you're using, the more likely you are to develop dry skin.

You can minimize dry skin by using an oil-free moisturizer as needed. Moisturizers labeled as "noncomedogenic" are less likely to block pores and lead to more acne.

Peeling and Flaking

Another side effect you'll probably notice: peeling, flaking skin. This condition is usually worse during the first few weeks of treatment, and slowly improves as your skin gets used to the medication.

Don't use too much, too quickly.  Start with a low dose, once a day. As you gradually become accustomed to benzoyl peroxide, you can work up to twice a day at a higher dose, if needed.

Redness and Irritation

Another thing benzoyl peroxide can do to your skin is make it red (sometimes really red) especially right after you use it. For most people, the redness appears immediately after use and fades within a few minutes to an hour, although it can last longer.

If your skin is very irritated, start with a lower concentration of benzoyl peroxide first, and move up. There is no reason to use a 10% benzoyl peroxide if a 2.5% will do. Using higher percentages increases your chance of irritation, and it doesn't always produce better or faster results.

Burning, Stinging, and Itching

Benzoyl peroxide can sting and burn when you apply it. In most cases, this is normal and dissipates after just a few minutes. 

You might even get some itchiness in the areas where you've applied your benzoyl peroxide medications. This irritation can happen either immediately after application, or sometimes a few minutes to hours afterward.

As long as it's mild and temporary, itching isn't a big deal. If the itching is more severe, you may want to discontinue use due to a possible allergy.

Stained Clothing or Towels

Benzoyl peroxide is an organic peroxide. In addition to being used for acne, it is used to bleach flour, hair, and teeth. If using benzoyl peroxide, you want to be aware that it can bleach clothing, towels, bedding, and hair.

Allergic Reactions to Benzoyl Peroxide

A 2018 study in Japan showed that as many as 4.5% of people may be allergic to benzoyl peroxide, and the number may be vastly undercounted. Just in case you are allergic, you may want to start on a small area of your face or body for the first three days.

Signs of an allergic reaction (contact dermatitis) include:

• Red and itchy rash
• Swelling
• Blisters
• Oozing

If signs of allergic contact dermatitis persist, discontinue use of benzoyl peroxide and try one of the other alternatives, either over-the-counter or prescription.

In rare cases, products with benzoyl peroxide can cause anaphylaxis, a life-threatening allergic reaction. Call 911 if you suspect signs of anaphylaxis, including:

• Tightness of the throat
• Dizziness or fainting
• Trouble breathing
• Swelling of the face, tongue, or lips

Preventing Benzoyl Peroxide's Side Effects

There are a few main ways to prevent side effects from benzoyl peroxide:

• Start with a lower concentration and work your way up.
• Start with daily application and work up to twice a day.
• Use a water-based, noncomedogenic moisturizer so that your skin doesn't dry out.
• Don't overuse it. Apply it as directed and only use one BP product at a time.
• If it doesn't seem to be helping, try a combined approach with products containing other active ingredients.
• If side effects don't seem to be improving, discontinue use and try something else.

Other OTC Acne Treatments

If you don't tolerate benzoyl peroxide well, or if you'd like to try something else, there are other over-the-counter (OTC) options available to treat acne. Because different acne medications work in different ways, a combination of treatments may work more effectively than one alone.

Salicylic acid

Salicylic acid (SA) is available without a prescription at 0.5% to 2% strengths. It helps to prevent pores from becoming plugged.

Sometimes combined with benzoyl peroxide (BP), some preparations are left on, and some are rinsed off. Although SA is less irritating than BP, it also doesn't seem to be as effective.

Tea Tree Oil

The essential oil from the leaves of the tea tree of Australia, tea tree oil may be helpful for acne, but more research is needed. Tea tree oil should only be applied topically, not taken internally.

Sulphur

Sulphur helps to remove excess oil and the dead skin cells that can clog pores. It can lead to dry skin and some people find the smell unpleasant. Sulphur is sometimes combined with or included in other acne medications.

Apha Hydroxy Acids

Alpha hydroxy acids help to remove dead skin and and decrease inflammation. This encourages the growth of new, smooth skin, making pores appear smaller and improving acne scars. The two main acids used in acne products are lactic acid and glycolic acid.

Adapalene

Differin (adapalene) is a retinoid-like compound that was previously available only by prescription. Adapalene is available as a cream, a liquid, a gel, and as a medicated wipe, usually applied once a day, at bedtime.

Adapalene may make acne worse at first, because it brings pimples to the surface. You may need to wait 12 weeks to see full results, and you should wear sunscreen with this product because it can make your skin more sensitive to light.

When to Call a Healthcare Provider

If you have been using benzoyl peroxide and your skin seems irritated, give your healthcare provider a call. You should also call if you develop a rash or blisters on your skin, or other signs of contact dermatitis.

Additionally, call your healthcare provider right away if you notice any signs of infection, such as:

• Redness
• Swelling
• Crusting
• Pain or warmth in the rash area
• Yellow or green pus
• Red streaks from blisters
• Fever

Summary

Benzoyl peroxide can be an effective acne treatment, but it does come with a slight risk of side effects, including dryness, peeling, and itching. Benzoyl peroxide allergy may result in a blistering rash for some people as well.

You can help prevent benzoyl peroxide side effects by first testing it on a small patch of your skin. Applying moisturizer regularly will also help to avoid dryness. If you do develop skin irritation or signs of infection, call your healthcare provider for an evaluation. Call 911 for signs of a severe allergic reaction, including trouble breathing, feeling faint, and facial swelling.