When you mention acne, most people think of teenagers. Indeed, an estimated 85 percent of people between the ages of 12 and 24 are troubled with pimples and at least minor acne at some point. However, a surprising number of adults also suffer with this condition. Approximately 50 million American adults have acne, and many of them take antibiotic pills or use topical antibiotics to treat it. That adds up to an awful lot of people on antibiotics! Are there other options? What about benzoyl peroxide for acne or rosacea?
Can Antibiotics for Acne Be Replaced?
Dermatologists at the University of Pennsylvania suggest that many women could take an old-fashioned diuretic called spironolactone instead (Barbieri et al, Journal of Drugs and Dermatology, June, 2018). Originally marketed under the brand name Aldactone, this water pill has anti-androgen activity. As a consequence, it is inappropriate as a treatment for men’s skin problems. But women often respond quite well.
When patient satisfaction was compared between spironolactone and oral tetracycline, there was no significant difference between the two groups.
The authors conclude:
“spironolactone may have similar clinical effectiveness to that of oral tetracycline-class antibiotics.”
Because so many people take antibiotics for acne, substituting spironolactone could significantly reduce the amount of antibiotic used by the population. This in turn would be a step to help reduce antibiotic resistance in bacteria.
Benzoyl Peroxide vs. Antibiotics for Acne or Acne Rosacea?
Benzoyl peroxide has been prescribed for over a decade. It works as an antiseptic. That is to say it eradicates bacteria found on the skin and in hair follicles. Dermatologists have attributed skin blemishes to “germs” such as C. acnes (Cutibacterium acnes, aka Propionibacterium acnes aka Corynebacterium parvum). Benzoyl peroxide is not an antibiotics, but it does kill bacteria such as C. acnes.
This reader has had a roller coaster ride with benzoyl peroxide:
“This is about benzoyl peroxide, a topical wonder drug. I’m 67, and have suffered from acne and rosacea since I was a teenager. You name it, the dermatologists tried it on me: benzoyl peroxide, antibiotics, Retin-A, UV light, diet, abrasive cleansers, “scrubbies,” sulfa drugs, and topical antibiotics. In my fifties, I am still suffering from periodic outbreaks.
“One day I was watching yet another infomercial for Proactiv. As usual, I was fairly sure that the testimonials were genuine, because the photos and the emotions of the relieved acne sufferers seemed authentic to this long-time victim. But for the first time ever, the commercial happened to reveal the principal active ingredient in the Proactiv program: benzoyl peroxide, the very first thing I’d been prescribed as a teenager — but which I’d never been able to tolerate.
“I had a container of an expensive peroxide scrub that my current dermatologist had prescribed, but which, as usual, I wasn’t using. I picked it up and read the instructions. I saw two words there that I’d never paid attention to: ‘Rinse well.’ I then recalled my dermatologist saying that benzoyl peroxide needs to stay on the skin for a full minute, and that the scrub needs to be 10% peroxide, rather than a lower strength; that was all.
“I’d always been reluctant to rinse too aggressively, thinking that some benzoyl peroxide needed to stay on the skin. Now, though, I resolved to follow the directions. I used the scrub in the shower, first thing, leaving it on for a minute and then rinsing really well, rubbing my face with my hands while rinsing. Then at the end of the shower, I rinsed again, the same way, to take care of any residue that had sweated from the pores. For the first time ever, my skin didn’t itch or feel irritated as the day wore on. Almost immediately, my rosacea disappeared, and within a couple of weeks, my skin was absolutely free of new pimples.
“My prescription scrub soon went generic, though, and I found the generic wasn’t effective, despite still costing an arm and a leg. I experimented with OTC scrubs, using my rosacea as a quick indicator of effectiveness, and found only one that worked: Oxy10 Acne Cleanser, Maximum Strength. It was dirt cheap, and totally effective.
“I’ve been using it ever since. (Caution: benzoyl peroxide is such a powerful bleach that, despite thorough face rinsing, you still have to use white towels and wash them by themselves, else you’ll bleach everything they’re washed with!) Benzoyl peroxide, used correctly, has been a life changer for me; I only wish I’d read those instructions more carefully 50 years ago.”
A. Benzoyl peroxide has been a mainstay of many popular acne treatments for decades. There is one concern, however. Recent research in the Journal of Investigative Dermatology (Oct. 2024) reveals that 34 percent of the various products tested contained unacceptably high levels of benzene. This compound is a carcinogen that has previously been detected in products such as hand sanitizers, sunscreens and spray antiperspirants.
You can read more about benzene problems at this link:
Carcinogenic Benzene Is Found in Acne and Rosacea Products
For a list of products with lower levels of benzene as well as alternatives for managing skin blemishes, you may wish to read our eGuide to Acne Solutions. This online resource may be found under the Health eGuides tab.
Sulfur Soap to Calm Acne:
Prescription antibiotics, benzoyl peroxide and spironolactone aren’t the only treatment for blemishes that may be helpful. Sometimes over-the-counter remedies work surprisingly well. One woman described her success with a very old-fashioned approach to clearing the complexion.
Q. I am a 41-year-old woman who never experienced acne until the past few years. I tried several medications, soaps and creams, but I found nothing to be particularly effective.
Recently, a friend recommended sulfur soap. I find it on the Hispanic product aisle.
After using it for a few weeks, my face is starting to clear up. Is this product safe? How could a bar of soap costing less than $3 be more effective than salicylic acid or benzoyl peroxide?
Sulfur Soap Is Antibacterial:
A. Topical sulfur is an old-fashioned skin treatment that has antifungal and antibacterial activity (Journal of Drugs in Dermatology, Jul-Aug., 2004). For decades, doctors have recommended its use for seborrheic dermatitis, rosacea, dandruff, scabies and warts, as well as acne. It does appear to be safe, although a few people may have a mild skin reaction.
Sulfur is found not only in bar soap, but also in some liquid face washing products and certain creams and lotions. It may be a helpful addition to an anti-acne regimen.
Final Words:
In our eGuide to Acne Solutions you will find lots more information about the causes of acne, medications that make this skin condition worse and a wide variety of treatment options. They include unusual uses for topical milk of magnesia (magnesium hydroxide) and old-fashioned amber Listerine. You will also learn which acne products containing benzoyl peroxide had acceptable levels of benzene below 2 parts per million.
Please share your own experience with acne remedies in the comment section below.
