Be Proactiv® about your Acne!
Acne is a common skin condition affecting a vast majority of teenagers and young adults. Those with acne often feel ashamed, embarrassed and isolated by their condition, especially if they live in a society which places great importance on physical beauty. Because acne is so common, many companies have come up with a wide variety of products to help consumers. For mild to moderate acne, you can look for a non-prescription option but we know it can be confusing because pharmacy aisles are full of acne cleansers and lotions. Finding the right products can be difficult and many individuals end up trying products that are very popular and well marketed, such as Proactiv®. The question you are probably asking is – ‘does the regimen work?’ We did a little bit of digging for you, so read on.
What is Proactiv®?
Proactiv® is a three-part acne treatment kit that includes a cleanser, toner and a treatment lotion and is the highest selling acne product in America1. This over-the-counter (OTC) product has benzoyl peroxide (BPO) 2.5% as its active ingredient, which is one of the most widely used first-line treatments in the management of mild acne2. Individuals on the regimen are advised to use it twice daily for 3-4 weeks to see a noticeable improvement. Adherence to therapy is important because acne clearance is usually seen 2-4 months after starting treatment. Long term use is recommended to prevent the reappearance of acne3.
How does it work?
There are four contributing factors to acne: excess oil production, abnormal cell growth within facial pores, increase of bacteria and inflammation1. Propionibacterium acnes (a type of bacteria) has been suggested to be the main culprit of acne. BPO, contained in Proactiv, has both an antibacterial and anti-inflammatory effect1,2 and works to eliminate the bacteria at the root of the acne problem as well as improve the overall appearance of the condition.
What does the evidence say?
There are currently no scientific studies that directly compare the Proactiv® treatment with other products containing the same active ingredient (BPO 2.5%) but a few studies look at the effectiveness of Proactiv® itself. There are however, many studies that support the use of BPO to treat mild to moderate acne. One study compared different concentrations of BPO (2.5%, 5% and 10%) and found that 2.5% BPO was just as effective at reducing the number of pimples as were higher concentrations of BPO4. This means that any product containing at least 2.5% BPO can be used to treat mild to moderate acne and higher concentrations may not provide an additional advantage. Higher concentrations of BPO also caused greater severity of side effects such as dryness, redness and peeling.
Many OTC acne treatments contain salicylic acid instead of BPO and evidence has shown that it is not more effective than BPO5. However, because salicylic acid does not have an antibacterial effect like BPO does, it is not recommended over BPO. When compared to prescription acne treatments such as adapalene, BPO was almost as effective at reducing the number of pimples6. It’s also frequently combined with prescription treatments such as antibiotic therapy to increase overall effectiveness and prevent antibacterial resistance which is common with prolonged use of antibiotics7.
Safety concerns and things to look out for
Proactiv® can cause mild skin irritation, like redness, peeling and a stinging sensation, that may improve after continued use4,7,8. It is recommended that individuals using a BPO product should stop using other topical acne treatments and avoid excessive time in the sun since sunlight can make the skin irritation worse8. Make sure to use sunscreen! Additionally, BPO has the potential to bleach hair and clothing if not used carefully and can leave an unpleasant odour on clothing and bedding9. Pregnant women should talk to their pharmacist or physician before using any BPO products.
While Proactiv® is just as effective as other BPO products, its popular appeal is due to widespread marketing, celebrity endorsements, visually pleasing packaging, money-back guarantee and easy to use 3-step program. However, there are multiple other skin care products available, similar to Proactiv®, which contain the same concentration of the active ingredient and with a similar price tag. Essentially, individuals with mild acne can use any acne product containing at least 2.5% BPO accompanied by a mild or soap-less cleanser and a non-comedogenic (doesn’t block pores) moisturizer with added sun protection (SPF ≥ 15) to get the same results as seen with Proactiv®. Individuals with moderate to severe acne are advised to speak to their pharmacist or physician for a more appropriate prescription acne therapy advice.
Mehnaz Anwar, Bryan Hodgson, Yen Nguyen, Phoebe Hsu, Raymond Lam, Katherine Nguyen, BSc. Pharm Candidate(s)
Faculty of Pharmacy and Pharmacuetical Sciences
University of Alberta
Edited and Reviewed by The Health Aisle Team
- Burkhart, Craig G. and Burkhart, Craig N. (2007). Treatment of acne vulgaris without antibiotics: tertiary amine–benzoyl peroxide combination vs. benzoyl peroxide alone (Proactiv Solution™). International Journal of Dermatology, 46:89–93.
- Benzoyl Peroxide. Martindale: The complete drug reference (2014). Retrieved from http://www.medicinescomplete.com.
- Proactiv. Clear skin treatments and tips. (2014). Retrieved from http://www.getproactiv.ca/howtouse.php?mboxSession=1397417189170-394933
- Mills OH Jr, Kligman AM, Pochi P, Comite H (1986). Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol, 25(10):664-667.
- Gross G (2007). Benzoyl peroxide and salicylic acid therapy. Acne and Its Therapy. New York, Informa Healthcare, 117-136.
- Nascimento LV, Guedes AC, Magalhães GM, de Faria FA, Guerra RM, de C Almedia F (2003). Single-blind and comparative clinical study of the efficacy and safety of benzoyl peroxide 4% gel (BID) and adapalene 0.1% gel (QD) in the treatment of acne vulgaris for 11 weeks. J Dermatolog Treat, 14(3):166-171.
- Bowe WP, Shalita AR (2008). Effective over-the-counter acne treatments. Semin Cutan Med Surg, 27(3):170-176.
- Akhavan A, Bershad S (2003). Topical Acne Drugs. Review of Clinical Properties, Systemic Exposure, and Safety. Am J Clin Dermatol, 4(7): 482.
- Sibbald, D. (2013). Acne. In C. Repchinsky (Ed.),Therapeutic Choices for Minor Ailments (1st ed., p. 594). Ottawa: Canadian Pharmacists Association.