July 1, 2015

Is Benzoyl Peroxide The Devil ?

In my 17 years of helping to clear Adult Acne, I’ve heard differing opinions about Benzoyl Peroxide, aka BPO.  Some say it’s the greatest thing since sliced bread when used properly, in a very specific protocol.  Others believe it damages the skin leaving it thinned out and oxidized, contributing to pigmentation issues and aging.  Some don’t like it just because it’s a “drug”, preferring a more “natural” approach.

But learning exactly what BPO does, how it works, and how it can actually help rather than hurt, took more than just hearing an opinion or two.  I’d like to share what I’ve learned with you, and perhaps demystify, and even shed a positive light on Benzoyl Peroxide.

You can read All About Acne to get a more detailed description of how acne forms in general.  But for our purposes right now, we're going to just focus on acne bacteria.

At the bottom of almost every pore in every human being is a type of bacteria known as Propionibacterium Acnes, also known as P. Acnes.  These bacteria are anaerobic, which means they breathe carbon dioxide and are suffocated by oxygen.  They thrive in a warm, oxygen-free environment.  So, as long as air is able to get inside your pores, they're kept in check.  But as soon as any kind of inflammation causes enough warmth and swelling to squeeze the pore shut, air runs out of the pore and the bacteria thrive.  

Benzoyl Peroxide sends oxygen right into the pore to kill P. Acnes bacteria.

Benzoyl Peroxide actually does 3 things.  First, it forces oxygen into pores, which kills the bacteria.  Next, it dries up excess oil inside.  Finally, it exfoliates from the inside out.  All three keep pores clear of infection and oil/dead skin cell build-up, which is exactly what is needed to clear acne.  It’s the only acne medication that does all three without killing good bacteria and without making your skin fall off.

So what’s the problem?

It can be irritating when too high a dosage is used, or when it's applied too often for the skin to handle at the time.  We don’t want to over-exfoliate the skin or dry up oil too quickly; we want the skin to have a chance to build itself back up and get stronger as it’s going through it’s healing process.

How is BPO used "properly" ?

We start out slow.  At night, after washing and toning, the skin is dried completely, leaving no moisture behind.  Starting out with a thin coat of 2.5% BPO, and making sure it penetrates very well, carefully avoiding the eye and lip area (no eye creams nor lip balms are to be used at this time), nothing else is applied on top (be aware that BPO can bleach clothes and pillow cases).  If the next day there is no inflammation or excess dryness, the same procedure can be followed the next night.  If there is, it can be applied for as little as half an hour and then rinsing off, adding another half hour every few days and the skin builds itself up and heals itself.  After it's rinsed, the regular nighttime skincare routine is followed. I find that most people seem to do well starting out with the procedure every other night, with their regular skincare routine of antioxidant serum and hydrating lotion being followed on the other nights.  Eventually they work their way up to BPO being used every night.

Here’s what throws most people off:  The small amount of dryness and flakiness that will result is actually supposed to happen!  It does not mean your skin is dried out or that you're allergic, it means the skin is peeling from inside the pores out.  If the flaking has redness and burning associated with it, then you would have to scale back to starting out by the hour instead of by the day.   We want your skin to be just flakey enough for you to see it up close in the mirror but not enough for others to see it from two feet away.

As the skin renews itself as a response to the exfoliation and begins to build itself back up, it appears to “get used to” the dosage being used at that time.  After a while, the skin will feel like it's not responding anymore.  At that point, the frequency would increase to every night.  Then after that, we might increase the dosage to 5%, and start the same way as the beginning of the use of the 2.5%.  A need for a dosage of 10% is actually quite rare in adults, especially when BPO is used in conjunction with hydrators, anti-inflammatories, and clay masks.

As soon as the skin is clear for three months straight, we would then back down with use of BPO in the opposite direction as we started; every other night, then every third night, then twice a week, once a week and then stop.  Some people find that they need BPO in their regular skincare routine for years.  Most, however, don't.

But does it do more harm than good ?

There are two schools of thought on this.  One says that the potential for free radical damage is too great, since the introduction of oxygen to the skin is so localized and happens in the midst of slight irritation, it’s too much of an addition of free radicals for the skin to handle and damage occurs.  The other says that just as much or more free radicals attack the body and skin from exercise, and very much more from sun exposure, so it doesn’t make a difference.  

My opinion?  When care is taken to make sure the skin doesn’t get too irritated, and skin is protected from the sun for dear life, BPO use can be temporary enough for us to benefit from it before we can let a maintenance program that doesn’t involve BPO take over.  When I do have a client using BPO, we keep in touch very regularly by email in order to monitor when it's time to increase the duration or dosage.

In my method of acne clearing, it’s not the first go-to, nor is it avoided.  I just find that with most cases of Adult Acne, a change in basic skin care routine, lifestyle and dietary changes, plus a careful monitoring of all products that can possibly touch the skin, are so often enough, I often don’t need to introduce BPO into the picture.  I must say, however, I do sell it quite a lot of it for certain ingrown hair and bacne problems.

So the question now is . . . 

All drugstore brands of Benzoyl Peroxide, I have found, contain pore clogging and/or pore irritating ingredients.  Incredible, I know.  Here’s the problem; Benzoyl Peroxide needs a totally dry surface with no emollients whatsoever in order to penetrate the skin.  So the lotion types, like Clearasil, for instance, have emollients that are meant to buffer and lubricate the skin against the dryness that people think means the product is irritating, which would make people stop buying it.  Thing is, this makes it completely ineffective!  Worse yet, the emollients usually chosen for this happen to be incredibly pore clogging, so even if the BPO gets into pores and flushes them out the way BPO is supposed to, you end up breaking out again from it 4-6 months later, necessitating another tube.  The gel types allow for proper penetration, but most contain an ingredient meant to stabilize and penetrate the product, that happens to be extremely irritating to pores in large amounts.  Not. Helpful.

The best formula of BPO that I have found, which comes in a nice size bottle for use on the face and body making it easier to use and less expensive in the long run, is from my mentor and acne guru Dr. Mark Lees, author of The Skincare Answer Book.  If you love all things skin, you need to get this book! 

Another way BPO can be of help:

Do you break out in tiny pimples a few days after a wax?  Here’s what happens.

As hair gets yanked out, oil glands get yanked on, spilling oil into pores.  If clogging from a lotion (no one needs lotion in the bikini area, by the way, your perspiration is enough), or pressure from clothes, makes it difficult for these pores to purge themselves of this oil, the oil will get stuck inside causing inflammation.  This leads to the tiny dots of redness and swelling you see in the first few days after your wax. 

If the pore then gets irritated enough to swell completely shut, that’s when bacteria can thrive and, as we’ve just seen above, the body goes to war and bingo!  Breakouts with tiny little white tops ensue.  This can happen elsewhere on the body as well, like face and underarms.

What to do?

A thin coat of 2.5% BPO applied right after the wax, and again for the next few nights, can actually stop this entire process.  Exfoliation might irritate the area further.  Wait for that until this particular breakout subsides - this is not an ingrown hair problem, this is different.  A Salicylic Acid gel is nice for this also, but BPO is faster and more effective.

Just remember, BPO necessitates sunscreen;  if an area will have any sun exposure at all, you MUST wear sunscreen!

So you see, whether your Adult Acne is genetic, hormonal, on your face or on your body, Benzoyl Peroxide requires quite a bit of hand holding, more than doctors are willing to provide (or even know how to) and more than many Estheticians are familiar with.  But we can figure this out together ! 

First step toward getting you clear is to fill out my Eval by Email® Online Skincare Consultation form, designed for ages Gen X to Baby Boom (mid 20s on up).  I’ll help you figure out the cause of your particular Adult Acne issue and advise on which of my products will help get your skin clear and healthy.  Anti-aging issues can be addressed at the same time, with potent, effective products that won’t break you out.

Want to get 10% off your purchase at my web store? Pin this blog post to any one of your Pinterest boards by pinning any one of the photos above, and email the link from your board of the pinned post to skin911@daniela.com along with a question about your adult acne, Rosacea or sensitivity problem. You will get a personalized discount code along with a detailed answer to your question.   Happy Pinning!

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