John Barbieri, MD, MBA

ACNE | Global Education Day 2025 ACNE Global Education Day 2025: join top experts online for clinical insights, treatment updates, and expert discussions at global-dermatology.com.

Please join us for Acne Global Education day on June 7th. We have an all-star cast lined up and it is going to be an outstanding session on everything acne. For more and to register:
www.global-dermatology.com/en/events/ac...

Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis - PubMed PROSPERO ID: CRD42024516472.

Some more evidence from a meta-analysis of 6 RCTs to support that subdermal implants (i.e. Nexplanon) are more likely to cause acne than hormonal IUDs (OR 2.21). Something to keep in mind for those concerned about acne who otherwise don't have strong preferences.
pubmed.ncbi.nlm.nih.gov/40069520/

Avoid:
❌ La Roche-Posay Effaclar Duo Dual Action Acne Tx
❌ Walgreens Acne Control Cleanser
❌ Proactiv Emergency Blemish Relief Cream BPO
❌ Proactiv Skin Smoothing Exfoliator
❌ SLMD Benzoyl Peroxide Acne Lotion
❌ Walgreens Tinted Acne Treatment Cream
❌ Zapzyt Acne Tx Gel

4. I'm thankful that we have been having this conversation over the past year to ensure the continued safe use of this foundational acne treatment. I look forward to continuing to work with others on this issue so that we can provide the highest quality care for those with acne.

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study - PubMed Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study

This aligns with generally reassuring epidemiologic data supporting the safety of benzoyl peroxide containing products (pubmed.ncbi.nlm.nih.gov/39002561/; pubmed.ncbi.nlm.nih.gov/38950699/; pubmed.ncbi.nlm.nih.gov/38909658/;

3. It appears the FDA agrees that the clinical risk is minimal, even for products being recalled (hence why recall is at the retail rather than consumer level). "Even with daily use for decades, the risk of developing cancer because of exposure to benzene found in these products is very low."

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.

2. As we found in our recent @JAMADerm study, there are likely opportunities for manufacturers to re-evaluate their formulation, production, and distribution practices to achieve the goal of minimizing the formation of benzene in benzoyl peroxide products.
jamanetwork.com/journals/jam...

1. The vast majority of products were found to have undetectable or extremely low levels of benzene, which is reassuring. It also highlights that our goal should be insignificant levels of benzene in these products as most manufacturers are able to achieve this goal.

Recalls small number of acne products for benzene contamination Voluntary recalls of acne products after FDA testing finds small number of proudcts with elevated levels of benzene

🚨 News Alert 🚨
The FDA just released an important update regarding benzene in benzoyl peroxide products (www.fda.gov/drugs/drug-s...). See below for my thoughts and products to avoid:

Benzene in benzoyl peroxide-how worried should we be? - PubMed Benzene in benzoyl peroxide-how worried should we be?

And finally, it is important to consider risks of benzoyl peroxide containing products in the context of other alternative acne treatments that would be required if we avoid these products (and then also topical antibiotics). 8/8
pubmed.ncbi.nlm.nih.gov/38909658/

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products - PubMed The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products

That being said, I believe we do have opportunities to improve formulation, production, and distribution practices to maximize the safety of benzoyl peroxide products.
pubmed.ncbi.nlm.nih.gov/39937513/
7/8

YouTube video by John Barbieri, MD Benzene (carcinogen) in benzoyl peroxide? Should we be worried? | Dermatologist explains

Finally, there are the general limitations of FAERS and the small sample size. Ultimately, we will need further input from the FDA and prospective studies, but given currently available data, I think the likelihood of clinically meaningful risk is low.
youtu.be/TYcZXjCzt8Q
6/8

There also doesn't appear to be any signal for leukemia/lymphoma, which are the main malignancies one might expect with benzene exposure based on prior studies. 5/8

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study - PubMed Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study

From a face validity standpoint, it is unlikely that BPO products have a 100x greater risk of lung cancer than smoking. If this were true, we should have easily observed it in our cohort studies. 4/8
pubmed.ncbi.nlm.nih.gov/39002561/

Makers of Proactiv, Clearasil, and Others Sued in Benzoyl Peroxide Acne Product Class Action /PRNewswire/ -- Wisner Baum filed multiple class actions alleging several companies sold benzoyl peroxide (BPO) acne products without warning consumers that...

Additionally, 100% of the reports are for Proactiv products, who reportedly are being sued about this issue, which again raises concerns about reporting bias. These lawsuits were likely started prior to March 2024 and could have influenced 2023 data 3/8
www.prnewswire.com/news-release...

Most worrisome, 22/23 of the identified case of malignancy are from 2023-2024, with only 1 reported from 2019-2022 (they don't evaluate earlier years). This is very concerning for reporting bias, potentially influenced by 3rd parties. Notably, you don't see a pattern like this for adapalene. 2/8

A Disproportionality Analysis on Benzoyl Peroxide and its Risk of Malignancy using the FDA Adverse Event Reporting System

A new report on the potential relationship between benzene and benzoyl peroxide was just released in @theJIDJournal. While I applaud continued efforts to address this important topic, I have some serious concerns with this study. 1/8
www.sciencedirect.com/science/arti...

I don't even know why we bother writing appeals these days. It seems like the reviewers do not even engage with the content of the letter and just repeat the same rationale as the original denial. I'd like to just skip and go straight to next step to avoid more delays :/

Yes, they likely do work! The effect is relatively mild, but they actually have outperformed even benzoyl peroxide in a couple of head to head trials. It is important to get a model with adequate fluence/irradiance.

At-Home LED Devices for the Treatment of Acne Vulgaris This systematic review and meta-analysis examines 6 studies to determine the safety and efficacy of different types of at-home light-emitting diode devices in reducing acne lesions.

jamanetwork.com/journals/jam...

There is growing interest in the role of home LED therapy for acne. In this systematic review and meta-analysis in JAMA Derm, we examine the evidence base for this treatment (TL/DR: it appears to have reasonable efficacy for mild acne):
www.massgeneralbrigham.org/en/about/new...

Severe Acute Respiratory Failure Associated With Trimethoprim/Sulfamethoxazole Among Adolescent and Young Adults: An Active Comparator-Restricted Disproportionality Analysis From the FDA Adverse Event... TMP-SMX may increase the risk of ARF/ARDS, requiring further validation in larger pharmacoepidemiological studies. Our findings lay the groundwork for future research to further investigate the safety...

While we often worry about SJS/TEN with TMP-SMX, it also can be associated with severe acute respiratory failure, particularly among younger individuals. Another reason to be very cautious about using it for acne:
pubmed.ncbi.nlm.nih.gov/40012193/

Sherry Ershadi, an amazing research fellow in our lab this year, has put together these incredible acne/rosacea patient handouts. Feel free to use them if you find them helpful:
barbierilab.bwh.harvard.edu/educational-...

Lately, we've seen a lot of discussion about the potential risk of benzoyl peroxide products breaking down into benzene. In this letter, we discuss some of the limitations with respect to the methodology and framing of the recent Kucera et al. article in the JID:
www.jidonline.org/article/S002...

YouTube video by John Barbieri, MD How good is the new Minocycline-MR (Emrosi) for rosacea | Dermatologist explains

Minocycline-MR 40mg was recently FDA approved for rosacea. In this video, I will review the clinical trial data and share my thoughts on where it fits among our existing treatment options:
#rosacea #minocycline #emrosi
youtu.be/103ncqVznGk

Safety and Effectiveness of Oral Nutraceuticals for Treating Acne: A Systematic Review - PubMed This systematic review suggests a possible role for nutraceutical supplements in the treatment of acne. Physicians should be prepared to discuss the evidence regarding the potential role of nutraceuti...

or some of our work on this topic, and the role of nutraceuticals more broadly in acne, check out:
pubmed.ncbi.nlm.nih.gov/37878272/
2/2

The causal association between polyunsaturated fatty acids and acne: A two-sample Mendelian randomization study - PubMed Our study indicates that high DHA levels and their ratios to total fatty acids have causal protective effects against acne, while high LA levels and omega-6: omega-3 ratio are associated with increase...

Just out in BJD, interesting MR study lending further support to the potential role of Omega-3 being helpful in acne. These findings align with small trials and observational studies suggesting Omega-3 may be useful. 1/2
pubmed.ncbi.nlm.nih.gov/39936505/

YouTube video by John Barbieri, MD Will using benzoyl peroxide for acne cause cancer? | Dermatologist explains latest studies

Also important to keep in mind that while we do want to identify strategies to reduce benzene to as close to zero as possible, I think these benzoyl peroxide products are still generally safe to use based on the data we have available:
youtu.be/LSylzH_ikU8

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.

Excited to share work with @labmuffin.com, Courtney Rubin, and James Pham, identifying how formulation characteristics might be associated with benzene levels in benzoyl peroxide products. Some helpful hypotheses to guide future product development.
jamanetwork.com/journals/jam...

YouTube video by John Barbieri, MD Why Accutane (isotretinoin) isn’t working | Dermatologist and acne expert explains

In this latest video, I review common reasons why isotretinoin is not working and how to address these clinical scenarios:
youtu.be/gEc2qxdEH6Q