BPO and Alternative Acne Options

Acne treatments have been in the spotlight more than usual recently, as Valisure and the US Food and Drug Administration (FDA) have examined benzoyl peroxide (BPO) products for benzene contamination.^1,2 At the same time, innovative new options are becoming available. Practical Dermatology spoke to Diane Berson, MD, and Emily Lebowitz Luks, MD, who practice together in New York City, about the BPO issue and their experience with a new acne treatment.

HOW MUCH DEMAND IS THERE FOR NEW OPTIONS
TO TREAT ACNE?

Diane Berson, MD: There have not been many new acne ingredients in the last 35 to 40 years. We have seen evolving formulations and vehicles with existing actives, various newer synthetic retinoids, and the addition of dapsone and clascoterone. There have also been new combination products, containing retinoids and antimicrobials. Therefore, it might be useful to have an effective new over-the-counter formulation for those with mild breakouts or those needing a maintenance regimen.

Emily Lebowitz Luks, MD: A few patients have brought up the news around benzoyl peroxide because they subscribe to various newsletters or news sources which highlighted the product recalls.

Dr. Berson: I don’t know if the benzene controversy is as much of an issue for dermatologists as it may be for our patients who are reading all of this. Some of them may find it to be irritating, though this is usually lessened by giving the patient helpful skincare recommendations. As long as benzoyl peroxide is kept at a stable temperature, it is supported by strong data. 

Dr. Lebowitz: The FDA found that only six products had elevated levels of benzene. More than 90% of the products they tested had acceptable levels. Of course, the Valisure study included more products. The question is: Can the findings from the FDA or Valisure studies be applied to everyday practice?

Dr. Berson: So far, the studies suggest that, if benzoyl peroxide products are heated—such as left in the sun or a hot car—that there may me a potential for release of benzene. We might just need more standardization of the studies; however, it is nice to have a novel ingredient that we can recommend to patients who might be concerned. 

SPEAKING OF OTHER OPTIONS, YOU WERE INVOLVED IN AN EARLY TRIAL OF A NEW OXYGEN-INFUSED TOPICAL TREATMENT. WHAT MADE YOU TRY THAT?

Dr. Lebowitz: We met with Dr. Harold Brody because he was involved with the product, Liquid Oxygen. It sounded like a nice option, especially for teenagers or young patients with mild acne who really want a clean, straightforward regimen. It contains three steps, twice a day: face wash, astringent, and moisturizer. The acne wash has salicylic acid. The astringent, which is a liquid, feels like a toner and removes excess dirt or oil that the face wash hasn’t removed. The moisturizer contains aloe and vitamins A, D, C, and E; the aloe is soothing to the skin, and as we know, vitamins A, D, C, and E also have antioxidant, anti-inflammatory, and photoprotective qualities. I’m excited about this product because patients are always looking for new and different options. Of course, the timing with the issues surrounding benzoyl peroxide made this new product intriguing.

Dr. Berson: Salicylic acid has always been a favorite ingredient of dermatologists since it helps keep the pores unclogged, reduces the appearance of pores, and can help decrease new breakouts. Having this oxygen product combined with salicylic acid is a nice benefit for patients. It will be nice to have an over-the-counter product with newer ingredients to offer to patients whose acne is mild. 

Dr. Lebowitz: This product definitely piqued the interest of patients who usually have good skin but still have breakouts here and there, and just want something that might help prevent acne without being “too strong.” The mechanism is interesting, too, because benzoyl peroxide releases oxygen and kills bacteria. The regimen has a very similar mechanism to that well-established one but without the potentially drying properties, making it a great option for sensitive skin.  

WHAT CAN YOU TELL US ABOUT THE STUDY?

Dr. Lebowitz: This was a very small, early pilot study, so it was not a double-blind, placebo-controlled scenario. Liquid Oxygen is already available on the market, but it has not been studied in a clinical setting. The goal was to get an idea of the quality and how it feels on the skin. The initial results have been positive.

DO YOU RECOMMEND IT IN COMBINATION WITH ANYTHING ELSE? 

Dr. Lebowitz: That’s a good question. For this pilot study, the point was to objectively evaluate its function on its own, so patients stopped any other acne medications they were using. Hypothetically, someone may be able to use the face wash and the toner in the mornings, for example, and then at night still use a retinoid. That’s where I think some of the art comes in when  incorporating other treatments. For some patients, Liquid Oxygen seems to be working well on its own. 

1. Kucera K, Zenzola N, et al. Benzyol peroxide drug products form benzene. J Environ Health Perspect. 2024. doi:10.1289/EHP13984

2. U.S. Food and Drug Administration. Limited number of voluntary recalls initiated after FDA testing of acne products for benzene; findings show a small number of products with elevated levels of benzene contamination. FDA. Published March 11, 2025. Accessed June 19, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/limited-number-voluntary-recalls-initiated-after-fda-testing-acne-products-benzene-findings-show