Dear Paula,

I've listened to all of your BlogTalkRadio programs, and I was especially interested in the one you and your team did about acne. I'm 34 and have rosacea, eczema, very sensitive skin, and mild acne. Oh, how I love your work! (And please, please, please do a rosacea program in the future!)

I use prescription BenzaClin or Duac on acne lesions, but I'm hesitant to put a layer of it on large parts of my face. It's very drying and I'm unsure of any benzoyl peroxide-induced free radical damage. My questions:

1. How much free radical damage does benzoyl peroxide really do? Should I switch to just a clindamycin spot treatment to avoid free radical damage?

2. I've looked for an alternative to benzoyl peroxide (I already use your 2% BHA Gel and love it). The only legitimate research I’ve been able to find concerns niacinamide. Does niacinamide have similar anti-acne properties to benzoyl peroxide?

Amy, via email

Dear Amy,

Thanks for listening to my Blogtalk Radio show! It has been a treat to be on air each week, I love it! As for your questions, it sounds like you have my skin type almost exactly.

My first thought is given you have sensitive skin and “mild acne” the prescription topical options could be too much for you. Duac and BenzaClin both combine 5% benzoyl peroxide with the topical antibiotic clindamycin, both in a basic gel formula that’s alcohol-free, so the dryness is probably from the combination of actives. Have you tried using a topical disinfectant with 2.5% benzoyl peroxide? You may find this amount works great for your mild acne without the bothersome side effects. Several companies offer such products, including mine (Paula’s Choice CLEAR Acne Fighting Treatment).

First, it is important to know that benzoyl peroxide is used with topical antibiotics to prevent the acne causing bacteria from adapting. You do not want to use a topical antibiotic that doesn’t contain benzoyl peroxide.

Second, it is suspected that benzoyl peroxide can cause free-radical damage, it does generate an extra oxygen molecule to kill acne-causing bacteria, but there is no research showing how much damage it causes. Most likely it isn’t any more than from the air itself. In fact, some research indicates that benzoyl peroxide has a protective effect on certain cells and the skin itself has enough antioxidant content to reduce oxidative sources which would include benzoyl peroxide—yet the benzoyl peroxide is still effective (Sources: The Journal of Organic Chemistry, February 2008, pages 1,217–1,224; and Skin Pharmacology and Applied Physiology, Supplement 14, 2001, pages 87–91).

Keep in mind that allowing acne to flourish puts skin at risk for significantly more damage from the immune response and resulting chronic inflammation. Left untreated, acne causes collagen breakdown and free radical damage all on its own.

In terms of niacinamide, it but it doesn’t work the same way as benzoyl peroxide. Niacinamide cannot kill acne-causing bacteria, but is certainly capable of reducing inflammation and helping produce healthy skin cell production, and that’s always beneficial for skin. The research pertaining to niacinamide and acne is about it’s ability to reduce the inflammatory response skin undergoes when acne-causing bacteria proliferates (Sources: Journal of Dermatological Science, November 2009, pages 106–112; and Journal of Cosmetic Dermatology, April 2004, pages 88–93).

Should you wish to experiment with niacinamide, several products in my Skin Balancing line contain this ingredient, including my best-selling Skin Balancing Toner. Of course, other brands, most notably Olay, use niacinamide in almost everything they sell (but those products aren’t designed for blemish prone skin as they are lotions and creams). Without question niacinamide has benefits for all skin types and for many skin conditions such as acne and discolorations. Rather than use it in place of benzoyl peroxide, I recommend you include it in your skin-care routine.

One more comment: based on your skin’s sensitivity and mild acne, it would be best to only apply the benzoyl peroxide product (whether prescription or over-the-counter) to your acne-prone areas.