Benzoyl Peroxide

Benzoyl Peroxide

PEP Topic 
Skin Reactions
Description 

Benzoyl peroxide, a chemical compound in the peroxide family, is a cleaning agent typically used in the treatment of acne. Benzoyl peroxide was evaluated in patients with cancer for the prevention and treatment of radiodermatitis and skin effects.

Effectiveness Not Established

Research Evidence Summaries

de Noronha e Menezes, N.M., Lima, R., Moreira, A., Varela, P., Barroso, A., Baptista, A., & Parente, B. (2009). Description and management of cutaneous side effects during erlotinib and cetuximab treatment in lung and colorectal cancer patients: A prospective and descriptive study of 19 patients. European Journal of Dermatology, 19, 248–251.

doi: 10.1684/ejd.2009.0650
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Study Purpose:

To evaluate the effectiveness of treating epidermal growth factor receptor–inhibitor (EGFRI)-induced rash using a topical antibiotic or a combination of an antibiotic and benzoyl peroxide for grade 1 rash, or systemic treatment (oral antibiotics) for grade 2 or higher rash eruption.

Intervention Characteristics/Basic Study Process:

On initiation of EGFRIs, all patients started sunscreen, a mild skin cleanser, and oatmeal cream daily. Patients with a grade 1 rash were treated with a topical antibiotic or an antibiotic and benzoyl peroxide. Patients with a grade 2 or higher rash eruption were treated with systemic treatment (oral antibiotics).

Sample Characteristics:

The study reported on a sample of 19 patients with lung and colorectal cancer who initiated therapy with EGFRI agents (erlotinib or cetuximab) and had skin alterations.

Setting:

Portugal

Study Design:

This was a prospective, descriptive study.

Measurement Instruments/Methods:

  • Clinical and photographic evaluation
  • National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3

Results:

  • Eighteen of 19 patients developed a grade 2 rash.
  • Of those 18 patients, 50% had a complete response to treatment with tetracyclines (mainly doxycycline).
  • Only one patient had grade 3 rash, which did not respond to minocycline.
  • None of the patients had to stop treatment with EGFRI therapy.

Conclusions:

Tetracycline antibiotic treatment, in combination with benzoyl peroxide, was effective in completely resolving EGFRI-induced rash in 50% of the sample.

Limitations:

  • This was a small, noncontrolled study.
  • A combination of interventions was used; therefore, determining the effectiveness of the individual interventions is difficult.

Molinari, E., De Quatrebarbes, J., Andre, T., & Aractingi, S. (2005). Cetuximab-induced acne. Dermatology, 211, 330–333.

doi: 10.1159/000088502
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Study Purpose:

To evaluate the effectiveness of systemic antibiotic treatments (oral doxycycline) and local treatment for skin rash in patients receiving cetuximab.

Intervention Characteristics/Basic Study Process:

Patients were prospectively evaluated by dermatologists from two phase 2 trials between October 2003 and May 2004. Dermatologists determined they would treat four patients with oral doxycycline; in three of those patients, a topical treatment (retinoid) was given as well. Other patients were treated with benzoyl peroxide (n = 1) or fusidic acid (n = 1).

Sample Characteristics:

  • The study reported on a sample of 13 patients with metastatic colorectal cancer who were receiving cetuximab once per week (400 mg/m2 on week 1 and 250 mg/m2 thereafter).
  • The cetuximab treatment was associated with oxaliplatin, 5-fluorouracil, and fusidic acid, or irinotecan.

Setting:

Service de Dermatologie et Service d’Oncologie, Hôpital Tenon, in Paris, France

Study Design:

This was a prospective trial.

Measurement Instruments/Methods:

Rash intensity was graded as mild, moderate, or severe.

Results:

  • Eleven patients treated with cetuximab (85%) developed skin lesions.
  • The six treated patients responded to classical modalities of doxycycline (n = 4), benzoyl peroxide (n = 1), and fusidic acid (n = 1). Skin lesions resolved in four weeks.
  • Five patients were not treated because the acneform rash was mild. In those patients, the rash resolved spontaneously, although cetuximab was continued at the same dose.

Conclusions:

Antibiotic treatments (oral doxycycline) and local treatments given to six patients receiving cetuximab were effective in resolving skin lesions.

Limitations:

  • This was a very small, nonrandomized trial.
  • The description of the measurement tool or method used to grade rash symptoms was inadequate, with no reliability and validity.
  • Treatment was determined by the dermatologist.
  • A combination of interventions was used; therefore, determining the effectiveness of the individual interventions is difficult.

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