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I wonder why HP creams aren't used more often as an alternative to BP? I am posting this item, plus two articles on the effectiveness of HP creams compared to BP for treating acne. What do you think?

Q: What is your opinion of 1% hydrogen peroxide in creams? One source describes the benefits and another warns that hybrogen peroxide makes it easier for free radicals to be produced. Can you help clear up this issue please? 07.07.04

A: By: Harry Elden

Free radicals are produced as intermediates of many biochemical reactions. The environment is loaded with free radicals, especially in areas where a lot of automobile exhaust and smog can be found. Hydrogen peroxide is a source of free radicals, as is oxygen when inhaled, and muscle mitochondria during recovery from exercise/exertion. The most effective non-prescriptive (OTC) anti-acne agent is benzoyl peroxide, mainly because it produces free radicals. Hydrogen peroxide is similar, but not exactly like benzoyl peroxide. It is much, much less irritating, not drying and is not a tumor promoter like benzoyl peroxide. But benzoyl peroxide has been used widely and extensively as an anti-acne agent, available now only when accompanied by a warning label. The benefits and risks are points to consider. There are major benefits to certain uses of hydrogen peroxide creams. Check the PubMed Search Engine of the United States National Library of Medicine: PubMed.gov. Also note the risks and decide which predominates for the use you intend. There are no formal prohibitions against using 1% hydrogen peroxide cream on human skin. On the contrary, there are many reasons why the esthetician might want to consider treating skin with an oxygenating formulations, especially when the client is past early adulthood. Human skin experiences hypoxia due to shunting of blood to muscles by the autonomic system when in distress. Skin surface becomes hypoxic with advancing age. Primary and secondary cigarette smoke also markedly decreases skin oxygen. Fortunately, human skin is richly endowed with anti-peroxide enzymes (catalase), which immediately converts hydrogen peroxide to oxygen and water. Thus, as soon as you apply the cream, peroxide is depleted and oxygen/water is produced.

Harry R. Elden, Ph.D., is recognized as a foremost laboratory scientist and clinical investigator in the field of esthetics. He holds a Ph.D. in physical chemistry and has extensive experience in laboratory research and clinical studies. He also has technology management, business and consulting experience, and he is an educator and trainer. Elden is president of Elden Associates-Esthetic Skin Care in Coral Gables, Florida. To reach him e-mail [email protected]

Harry Elden

Efficacy and Safety of Stabilised Hydrogen Peroxide Cream (Crystacide) in Mild-to-Moderate Acne Vulgaris: A Randomised, Controlled Trial Versus Benzoyl Peroxide Gel

Massimo Milani, Andrea Bigardi, Marco Zavattarelli

Curr Med Res Opin 19(2):135-138, 2003. © 2003 Librapharm Limited

Posted 05/23/2003

Summary and Introduction

Summary

Background: Benzoyl peroxide (BP) is a first-line topical treatment in acne vulgaris (AV). However, its use can cause mild skin irritation and dryness. A new formulation of hydrogen peroxide stabilised (HPS) in monoglycerides cream (Crystacide* 1%), indicated in the topical treatment of superficial skin infections, is now available as an alternative treatment.

Study Aim: To evaluate efficacy and local tolerability of HPS in mild-to-moderate AV in comparison with BP gel.

Methods and Patients: In a randomised, prospective, investigator-masked parallel-group, 8-week trial, 60 patients (24 men, 36 women, mean age 25 ± 6 years) with mild-to-moderate AV, affecting mainly the face, were enrolled in the study, after their informed consent. HPS or BP (PanOxyl†gel 4%) was applied topically twice daily for 8 weeks.

Study Outcomes: The study endpoints were: (1) Reduction in mean inflammatory (IL), non-inflammatory (NIL) and total (TL) acneic lesions in comparison with baseline; (2) Local tolerability assessed evaluating erythema, dryness and burning sensation, using a 0-3 qualitative score (score 0 = poor tolerability; score 3 = very good tolerability).

Results: TL, NIL, and IL were assessed by an investigator unaware of treatment allocation at baseline, and week 8. The tolerability score (TS) was assessed at week 4 and 8. At baseline, the two groups were well matched for the main clinical and demographic characteristics. All patients concluded the trial. At week 0, in the HPS group TL, NIL and IL (mean ± SD) were: 35 ± 8, 20 ± 6 and 16 ± 7. At week 8, HPS reduced TL to 16 ± 7; NIL to 9 ± 3 and IL to 7 ± 3 (p < 0.001). At baseline, TL, NIL and IL, in the BP group, were 32 ± 9, 24 ± 8 and 18 ± 7, respectively. At week 8, BP reduced TL, NIL and IL to 14 ± 9; 7 ± 5 and 7 ± 3 (p < 0.001). In comparison with baseline values, the percentage reductions of IL were 58% and 61% for HPS and BP, respectively (p = n.s.). At the end of the study the TS was 2.9 ± 0.2 in HPS group and 2.4 ± 0.8 in BP group (p < 0.025). Two patients in HPS group (6%) and seven patients (23%) in BP group suffered from mild-to-moderate local erythema.

Conclusions: HPS has shown to be as effective as BP in reducing both inflammatory and non-inflammatory AV lesions in patients with mild-to-moderate disease. In comparison with BP 4% gel, HPS cream shows a better local tolerability profile.

Skin tolerability and efficacy of combination therapy with hydrogen peroxide stabilized cream and adapalene gel in comparison with benzoyl peroxide cream and adapalene gel in common acne. A randomized, investigator-masked, controlled trial.

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Br J Dermatol. 2004; 151(2):481-4 (ISSN: 0007-0963)

Capizzi R; Landi F; Milani M; Amerio P

Clinica Dermatologica, Policlinico Universitario Agostino Gemelli, Rome, Italy.

BACKGROUND: Combination therapy with antiseptics such as benzoyl peroxide (BP) and topical retinoids is widely used as first-line treatment for acne vulgaris (AV). However, these combinations could have a suboptimal skin tolerability. Recently, a new formulation of hydrogen peroxide (HP) 1% in stabilized cream (Crystacide; Mipharm, Milan, Italy) became available. A previous clinical study has shown that HP cream monotherapy presents a better skin tolerability in comparison with BP in patients with mild AV. OBJECTIVES: To evaluate the tolerability and the efficacy of combination therapy with HP cream and adapalene 0.1% gel in comparison with the combination of BP 4% cream and adapalene 0.1% gel in the treatment of mild to moderate AV. METHODS: In a randomized, investigator-blinded trial, 52 patients (mean +/- SD age 25 +/- 6 years; 19 men and 33 women) with AV were randomly assigned to HP cream and adapalene gel (group HP + A) or to BP cream and adapalene gel (group BP + A), for eight consecutive weeks. Efficacy was assessed by total (TL), inflammatory (IL) and noninflammatory (NL) lesion counts performed at baseline and weeks 4 and 8. Tolerability was assessed by evaluating skin erythema, burning and dryness at weeks 4 and 8. RESULTS: All patients completed the study. At baseline, the mean +/- SD numbers of TL, IL and NL were 44 +/- 9, 25 +/- 7 and 19 +/- 6 in group HP + A and 40 +/- 9, 21 +/- 7 and 19 +/- 9 in group BP + A, respectively. At the end of the treatment period, TL, IL and NL were reduced by 93%, 92% and 95%, respectively, in group HP + A and by 88%, 86% and 90%, respectively, in group BP + A. A significantly (P = 0.0025) greater reduction in NL was observed in group HP + A in comparison with group BP + A. Tolerability was significantly better in group HP + A in comparison with group BP + A (P = 0.02). Skin dryness and burning sensation were more frequent in group BP + A. CONCLUSIONS: The combination of adapalene and HP cream is an effective topical treatment regimen in mild to moderate AV. This combination has shown a better tolerability profile in comparison with the combination of BP and adapalene.

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That's interesting, reading this made me think any oxidizing cream shouldwork with acne. Plus Hydrogen peroxide creams sound like they don't carry this risk of cancer. But now in days, what doesn't?

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That's interesting, reading this made me think any oxidizing cream shouldwork with acne. Plus Hydrogen peroxide creams sound like they don't carry this risk of cancer. But now in days, what doesn't?

Where can you get the HP creams?

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Hydrogen peroxide is a bleaching agent, and is used as a disinfectant, the same way Benzoyl peroxide is. Peroxides are powerful and highly reactive chemicals. Just like Benzoyl Peroxide, it produces free radicals which over time can damage your skin. And if you have even tan skin leaving it on your face every night can bleach your skin color. That's why it's not common.

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Hydrogen peroxide is a bleaching agent, and is used as a disinfectant, the same way Benzoyl peroxide is. Peroxides are powerful and highly reactive chemicals. Just like Benzoyl Peroxide, it produces free radicals which over time can damage your skin. And if you have even tan skin leaving it on your face every night can bleach your skin color. That's why it's not common.

Is that why my face is so pale after using BP? :eh:

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Hydrogen peroxide is a bleaching agent, and is used as a disinfectant, the same way Benzoyl peroxide is. Peroxides are powerful and highly reactive chemicals. Just like Benzoyl Peroxide, it produces free radicals which over time can damage your skin. And if you have even tan skin leaving it on your face every night can bleach your skin color. That's why it's not common.

I guess what I meant was why it isn't used more often than BP (which would have the same issues with skin damage - although the extent to which HP/BP damages your skin is still unclear at this time). If it is less harsh than BP, less drying, but works as well - it seems like it would get used more often.

That's interesting, reading this made me think any oxidizing cream shouldwork with acne. Plus Hydrogen peroxide creams sound like they don't carry this risk of cancer. But now in days, what doesn't?

Where can you get the HP creams?

I think that Philosophy's "On a Clear day" line has an HP cream product. Clearasil makes an HP product too - but I don't know if it is a cream or gel. I think someone posted on this product recently. If you google hydrogen peroxide creams you might come up with some lesser known brands.

I have one that is from my esthetician's line. I use it during the day, and use 5% BP only at night on my breakout prone areas. The cream goes on so much nicer than the BP.

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Is that why my face is so pale after using BP? :eh:

Probably, especially if you're using a lot of it at a higher concentration (10%).

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Yeah, skin (and hair!) bleaching can be a problem with both of these products. I always make sure to keep it away from my hairline and my eyebrows. I am still really liking the HP cream that I am using during the day. It goes on so much nicer than the BP, and doesn't dry me out as much.

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