An inexpensive OTC topical preparation, benzoyl peroxide, combats acne just as well as, if not better than, antibiotics.

Researchers in England recruited 649 volunteers (median age 19) with moderate acne vulgaris and randomized them into five treatment groups, each receiving a placebo plus either an antibiotic or benzoyl peroxide or a combination of both active agents. After 18 weeks, 60% of those using benzoyl peroxide had fewer inflamed lesions compared with 54% of those using tetracycline and 55% of those using minocycline. The best treatment was a combination of topical tetracycline and benzoyl peroxide, with 66% of patients showing improvement.

“Acne isn’t an infection in the classic sense,” the researchers said.  “Direct anti-inflammatory activity could be as important as inhibition of propionibacterial growth, or even more important” (Lancet. 2004;364:2188-2195). They also pointed out that benzoyl peroxide was 12 times more cost-effective than minocycline.

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Benzoyl peroxide is available in the United States in creams, gels, lotions, soaps, and shaving creams under the brand names Benzac, Clearasil, Desquam, Oxy 10, and PanOxyl, among others.