benzoyl peroxide and tretinoin topical

Action and Spectrum

Actions and Spectrum: 

Actions: 

benzoyl peroxide has antimicrobial properties, particularly against the bacteria Propionibacterium acnes (P. acnes), which contributes to the development of acne. It helps to reduce the number of acne-causing bacteria on the skin’s surface. 

benzoyl peroxide has mild anti-inflammatory effects, which can help reduce redness and swelling associated with acne. tretinoin is a vitamin A derivative that normalizes the skin cell turnover process. It promotes dead skin cell shedding, preventing their accumulation and reducing the formation of comedones. 

Spectrum: 

tretinoin effectively treats various forms of acne, including comedonal, inflammatory, and cystic acne. It is also used for acne maintenance therapy and can help improve overall skin quality and texture. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Erythema, mild (33%) 

Pigmentation, mild (27.3%) 

Itching, mild (11.1%) 

Application site pain (10.6%) 

Dryness, mild (22.3%) 

Scaling, mild (16.4%) 

1-10% 

Erythema, moderate (6.9%) 

Stinging, mild (5.3%) 

Dryness, moderate (5.3%) 

Pigmentation (6.3%) 

Burning, mild (5.9%) 

Application site dryness (4.9%) 

Scaling, moderate (2.6%) 

Burning, moderate (2.2%) 

Application site exfoliation (4.1%) 

Application site erythema (4%) 

Itching, moderate (1.8%) 

Application site pruritus (1.3%) 

Application site irritation (1.1%) 

Application site dermatitis (1.3%) 

<1% 

Pigmentation, severe (0.4%) 

Erythema, severe (0.2%) 

Dryness, severe (0.4%) 

Stinging, moderate (0.2%) 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

• Hypersensitivity 
• Sun sensitivity 
• Irritated or damaged skin 
• Concurrent use with topical meds 
• Pregnancy 
• Breastfeeding 

Pregnancy / Lactation

Pregnancy consideration:  

Data is unavailable regarding the use of the drug during pregnancy. 

Breastfeeding warnings:  

No data is available regarding the excretion of the drug in breast milk. 

Pregnancy category: 

Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: No data is available for the drug under this category. 

Pharmacology

Pharmacology: 

benzoyl peroxide exhibits bactericidal activity against Propionibacterium acnes (P. acnes), a bacterium involved in the pathogenesis of acne. It releases oxygen-free radicals that have antimicrobial effects, reducing the population of P. acnes on the skin.  

benzoyl peroxide has keratolytic properties, which help break down keratin, a protein in the skin. Promoting exfoliation helps remove dead skin cells and unclog pores, reducing the formation of comedones (clogged pores).  

tretinoin is a retinoid that binds to and activates specific nuclear receptors, known as retinoic acid receptors (RARs). By binding to RARs, tretinoin regulates gene expression, leading to various cellular and physiological effects. 

Pharmacodynamics: 

benzoyl peroxide acts as a keratolytic agent, meaning it helps exfoliate and shed dead skin cells. Promoting the sloughing of dead cells prevents the formation of comedones (clogged pores) and assists in clearing existing comedones. 

It may help reduce inflammation associated with acne lesions, leading to a decrease in redness and swelling. 

tretinoin influences the differentiation and maturation of skin cells. It encourages the proper development and organization of skin cells, leading to a healthier and more balanced skin structure. 

Pharmacokinetics: 

benzoyl Peroxide 

Absorption 

benzoyl peroxide is topically applied to the skin and is generally poorly absorbed systemically. It primarily acts locally at the site of application.  

Distribution 

After application, benzoyl peroxide remains mainly in the outer layers of the skin. It does not extensively penetrate deeper tissues or systemic circulation.  

Metabolism 

benzoyl peroxide undergoes minimal metabolism in the body. It is metabolized to benzoic acid, metabolized, and excreted in the urine.  

Elimination and Excretion 

The elimination of benzoyl peroxide and its metabolites occurs mainly through renal excretion.  

tretinoin 

Absorption 

tretinoin is also topically applied to the skin. It gets absorbed through the skin and into the systemic circulation. The extent of absorption varies depending on factors such as the concentration of tretinoin; the formulation used, and the skin condition.  

Distribution  

Once absorbed, tretinoin is distributed to various tissues, including the skin layers. It crosses the blood-brain barrier and placental barrier.  

Metabolism 

tretinoin undergoes metabolism primarily in the liver. It is metabolized to various metabolites, including the active metabolite, all-trans retinoic acid.  

Elimination and Excretion 

The elimination of tretinoin and its metabolites occurs through renal excretion and liver metabolism. 

Adminstartion

Administration: 

Before application, clean & dry the affected area. Apply a bit of the cream or ointment as a fine layer to the affected area. Gently rub or spread the medication over the bruise. 

Wash your hands after the application of the medication. Follow the product labeling for specific instructions or as directed by your healthcare professional regarding the frequency of application and duration of use. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: benzoyl peroxide/tretinoin topical Pronounced: TRET-i-noyn-and-BEN-zoe-il-per-OX-ide 

Why do we use benzoyl peroxide/tretinoin topical? 

The combination of drugs is used topically as an antimicrobial and keratolytic agent to reduce inflammation, unclogging of pores, and improve texture.