Comparative Study of Two Topical Therapies

ORIGINAL ARTICLE
Comparative Study of Two Topical Therapies in Acne - Benzoyl Peroxide (2.5%)
& Retinoic Acid (0.025%)
Pandya Purna1*, Pethani Neha3, Pandya Ishan2,
1
Assistant Professor, Department of Dermatology, Venereology and Leprology, GMERS Medical College, Gandhinagar
2
Consultant, Dermatologist & Cosmetologist, Karmdeep Hospital, 102 Sarthak-2 Complex Swastik Cross Road, Admedabad
3 nd
2 Year Resident,Department of Dermatology, Venereology and Leprology, Sumandeep Medical College, Baroda

ABSTRACT
BACKGROUND: ―A disease does not have to be fatal, incurable, or physically crippling to be devastating. Acne
Vulgaris causes emotionally devastating effect by disfiguring the face that an adolescent turns to be the world he is
just beginning to confront.‖ Man has always remained conscious about his looks. Therapy of Acne is always an
interesting and important subject for medical personnel and laymen equally. A battalion of ―effective drugs‖ can
be obtained from allopathic and indigenous systems of medicine. Various topical agents have established their
role as anti-acne measures. Inspired by this fact, present study aims to study comparative effect of two topical
agents: Benzoyl Peroxide (2.5%) (BP) & Retinoic Acid (0.025%)(RP). MATERIALS AND METHODS: This
was a prospective cum retrospective study on 200 patients.The study was carried out from May 1999 to January
2001in Department of Dermatology, Venereology and Leprologyat B. J. Medical College General
Hospital,Bapunagar, Ahmedabad,Gujarat, India. Each patient underwent history asking and examination. Note
was made of the sex, age, occupation, complaints, family history, aggravating factors, type and site of skin
lessions. RESULTS: Out of 200 patients,66% of patients were in the age group 16-25 year, late teenager taking
the lead with 52%, (p<0.0001). Students (128, 64%) comprised a major group (p<0.0001) and this coincided with
the age incidence as well. Cosmetic look was common complaint from 100% of patients. Face was the
commonest site to develop acne (89%). Males suffered more from severe disease (Grade III & IV) as compared to
females. At the end of 4 months, 99% of patients showed very good to excellent response in BP group compared
to 76% of patients in RA group. CONCLUSION: From our study we may conclude that in long follow up after 4
months, both benzoyl peroxide (BP) and Retinoic acid (RA) were effective in clearing acne, but initial worsening
was more in case of RA compared to BP. Significant response was seen with BP after 3 weeks, whereas after 6
weeks with RA. Both drugs showed effect on inflamed lesions, but BP showed more rapid action.
Key words: Acne Vulgaris, Benzoyl Peroxide (2.5%) (BP), Retinoic Acid (0.025%)(RP).

INTRODUCTION
―A disease does not have to be fatal, incurable,
or physically crippling to be devastating. Acne
Vulgaris causes emotionally devastating effect
by disfiguring the face that an adolescent turns
to be the world he is just beginning to confront.‖
Acne vulgaris called before 19th century as
‗ionthi‘ and ‗vari‘ in Greek & Latin respectively
was recognized to be a disease of youth by
Greek Physicians 2500 years back. In Greek
‗ionths‘ means first growth of secondary sexual
hair & Greek physicians probably saw the
relation between the disease & the event. 1
Man has always remained conscious about his
looks. Therapy of Acne is always an interesting
and important subject for medical personnel and
laymen equally. A battalion of ―effective drugs‖
*
Corresponding Author
Dr. Pandya Purna
Assistant Professor, Department of Dermatology,
Venereology and Leprology, GMERS Medical
College, Gandhinagar
Email: papandya@yahoo.com
can be obtained from allopathic and indigenous
systems of medicine.
As etiopathogenesis of acne is being revealed,
effective measures for acne are rationalized
more and more. It is no longer a shot in dark.
Various topical agents have established their role
as anti-acne measures.
Inspired by this fact, present study aims to study
comparative effect of two topical agents:
Benzoyl Peroxide (2.5%) & Retinoic Acid
(0.025%). In this paper we study clinical
response of individual drug and compare
efficacy of drugs.
MATERIALS AND METHODS
This was a prospective cum retrospective
study.The study was carried out from May 1999
to January 2001in Department of Dermatology,
Venereology and Leprologyat B. J. Medical
College General Hospital,Bapunagar,
Ahmedabad,Gujarat, India.

33 Int J Int Med Res. 2016; 3(3):33-36 e ISSN: 2393-9869 p ISSN: 2350-0360
 Comparative Study of Two Topical Therapies

Selection of patients: were considered significant when P-Value

1. Patients having cystic and <0.05.
nodulocysticacne were excluded RESULTS AND DISCUSSION
2. Patients having acne other than acne Out of 200 patients, 124 (62%) were male and
vulgaris e. g. oil acne, senile comedones, 76 (38%) were female; the male-female ratio
infantile acne were excluded being 1.63: 1. RA was given to 90 (45%) and BP
3. 4 months being a long follow up, patients to 110 (55%) patients. It was seen that 66% of
who could come for regular follow up patients were in the age group 16-25 year, late
were selected teenager taking the lead with 52%, (p<0.0001).
Each patient underwent history asking and In 10-15 year age group, males were surpassed
examination. Note was made of the sex, age, by females. In 16-20 years group, male patients
occupation, complaints, family history, surpassed the female patients (Table 1).
aggravating factors, type and site of skin lesions. Table 1: Distribution of patients according to
Examination: Counting of lesions was done in age and gender
good nature light with the help of a hand lens. Age in year Male Female Total
In follow up examination, same method was No. Percent No. Percent No. Percent
employed and ultimate response was noted in 10 - 15 16 08% 36 18% 52 26%
percentage expression. 82 41% 22 11% 104 52%
16 - 20
Grading: The criteria for grading were as
21 - 25 18 09% 10 05% 28 14%
follow:
Grade Total number of lesions 26 - 35 08 04% 08 04% 16 08%
I < 10/100 cm2 These observations accord well with results of a
II 10 – 20/100 cm2 large study (1555 subjects) done by Burton et
III 20 – 30/100 cm2 al.2 The study concluded that the onset of
IV > 30/100 cm2 clinical acne is earlier (10-15 year) in females
than males whereas in older age group (15-18
Method: 110 patients were given benzoyl year), the incidence of clinical acne is more in
peroxide gel (2.5%) and 90 patients were given males than females. In present study, grouping
retinoic acid cream (0.025%). Patients were of age is done differently in which 16-20 year
instructed to apply medication at night. The group, more or less representing post pubertal
medication was mildly applied into the skin. group of Button (15-18 years), males
Patients were told not to discontinue the present outnumbered the females in having clinical acne.
therapy unless serious side effects were The observation in present study, that of all,
observed. Determination of response: At each 52%of patients were in age group 16-20 years, is
follow up examination, total number of lesions a reflection of Cunliffe‘s3 observation. He did
was counted. The response was determined by extensive study in 2155 subjects and found that
calculating the reduction in the total number of persons of 18 years had highest clinical acne
the lesions that were recorded at pretrial prevalence.
examination and response was graded as shown Figure 1 indicates that students (128, 64%)
in following table: comprise a major group (p<0.0001) and this
Reduction in total no. of coincides with the age incidence as well.
Response graded
lesions (%)
0 - 20 poor response An emphasis was made to enquire into
20 - 40 just response complaints of patients. It is of no wonder that
40 - 60 moderate response nobody denied the ―bad look‖. Oiliness of face
60 - 80 very good response was also complained of in majority, in about
80 - 100 excellent response
50% of patients. Burning pain was an
If the total number of lesions on follow up
occasional complain chiefly when modules arose
examination were more than the number at
(Table 2).
pretrial examination, the response was noted as
Face was the commonest site to develop acne
worsening.
(89%) compare to neck, back chest, shoulder,
Variables were evaluated and analyzed
and arm (p < 0.0001); although it is not
statistically. Chi-square (χ2) and Student
uncommonly spared in some patients (22, 11%).
ttestswere used to compare variables and tests
34 Int J Int Med Res. 2016; 3(3):33-36 e ISSN: 2393-9869 p ISSN: 2350-0360
 Comparative Study of Two Topical Therapies

Chest and back were affected in 23%, and 60% Cunliffeet al.3 involvement of face was 99%,
respectively (Table 3). In a study done by back in 60%, and chest in 15% patients.
Fig 1: Occupation & the Prevalence of Acne

Fig 1: Occupation & the Prevalence of

Acne
128, 64%
150
100 27, 13% 29, 15%
16, 8%
50
0
Study Domestic Sedentary Labourers
Workers workers

Table 2: Complaints of the patients Initial worsening was more in case of RA group
Complaints Male Female Total compared to BP group. Patients were
No. Percent No. Percent No. Percent
Cosmetic look 124 62% 76 38% 200 100% complaining of erythema, exfoliation in addition
Oiliness 62 31% 38 19% 100 50% to new lesion. In female patients, worsening
Itching 06 03% 05 2.5% 11 5.5%
Burning pain 02 01% 03 1.5% 5 2.5%
was also due to premenstrual aggravation. None
Table 3: Site of Lesions & Grade of Severity of the patient showed worsening after 4 weeks
Complaints Male Female Total (Table 4).
No. Percent No. Percent No. Percent Mild to very good response in more than 50% of
Face 102 51% 76 38% 178 89%
Neck 7 3.5% 2 1.0% 8 04% patients was seen after 2 weeks in BP group and
Back 74 37% 46 23% 120 60% after 4 weeks in RA group. Very good to
Chest 26 13% 20 10% 46 23%
Shoulder 6 03% 0 00% 6 03% excellent response in more than 50% of patients
Arm 6 03% 1 0.5% 7 3.5% was seen after 4 weeks in BP group, whereas in
Grade Male Female Total
No. Percent No. Percent No. Percent
RA group, it was seen after 8 weeks.
I 18 09% 10 05% 28 14% At the end of 3 months, about 96% of patients
II 02 01% 6 03% 8 04% had shown very good to excellent response in
III 24 12% 10 05% 34 17%
IV 80 40% 50 25% 130 65% BP group compared to 76% of patients in RA
It is observed that males suffered more from group. At the end of 4 months, 99% of patients
severe disease as compared to females (Table 3). showed very good to excellent response in BP
Random studies by Burton et al and Cunliffe4 group compared to 76% of patients in RA group.
also concluded that males are affected more with It was seen that inflamed lesions cleared rapidly
severe acne than females. These observations compared to non-inflammatory lesions in both
reflect: 1) Higher secretary rate of sebum in BP and RA groups.
males than in females, 2) More cosmetic
consciousness in females at an early stage.
Table 4: Response of the patients
Week 1 2 3 4 6 8 12 16
Res. Drug BP RA BP RA BP RA BP RA BP RA BP RA BP RA BP RA
(#) 17 31 4 25 8 11 0 2 0 0 0 0 0 0 0 0
W
% 15 34 4 27 7 12 0 2 0 0 0 0 0 0 0 0
(#) 68 58 44 49 10 41 11 20 5 11 4 6 1 3 0 0
N
% 62 62 40 56 9 46 10 22 4 13 4 6 1 3 0 0
(#) 22 3 20 15 12 27 4 36 3 19 0 3 0 1 0 0
M
% 20 4 18 16 11 30 4 40 3 21 0 3 0 1 0 0
(#) 3 0 38 1 64 11 34 27 18 48 8 43 3 18 1 5
G
% 3 0 34 1 58 12 31 30 17 52 7 48 3 20 1 6
(#) 0 0 4 0 11 0 53 5 41 11 23 25 8 30 6 22
V
% 0 0 4 0 10 0 48 6 37 13 21 28 7 34 5 24
(#) 0 0 0 0 5 0 8 0 43 1 75 13 98 38 103 63
E
% 0 0 0 0 5 0 7 0 39 1 69 15 89 42 94 70
W-- Worsening, N-- 0-20% response, M—20 to 40% response,
G – 40 to 60% response,V—60 to 80% response, E—80 to 100% response

35 Int J Int Med Res. 2016; 3(3):33-36 e ISSN: 2393-9869 p ISSN: 2350-0360
 Comparative Study of Two Topical Therapies

In a comparative study done by Balknap et al 8. Hughes Br, Morric C et al. Keratine

(98) in 19795, he concluded that BP and RA both expression in pilosebaceous epithelia in
were effective in reducing the number of both trunkal skin of acne patients. Br J Dermatol
inflammatory and non-inflammatory lesions. 1996; 134: 247-56
The BP gel appeared to produce more effect on
inflammatory lesions than did RA and BP
produced significantly less peeling.
In another study done by Hughs et al (99) in
19926, he concluded that BP had more rapid
effect on inflamed lesions compared to
Isotretinoin (0.05%). Acne grade has improved
significantly in BP group by 4 weeks and in the
isotretinoin group by 8 weeks.
Results of our study are also comparable and
consistent with above mentioned studies.
CONCLUSION
Both benzoyl peroxide (BP) and Retinoic acid
(RA), were effective in clearing acne, but
differenceobserved was that initial worsening
was more in case of RA compared to BP.
Significant response was seen with BP after 3
weeks, whereas after 6 weeks with RA. Both
drugs showed effect on inflamed lesions, but BP
showed more rapid action. In long follow up
after 4 months, both drugs showed equal
efficacy.
BP and RA both were equally effective, but BP
was rapidly effective with fewer incidences of
side effects.
REFERENCES
1. Goolmali S. K., Andison A. C. (1977): The
origin and use of word acne Br J Derm
96/291.
2. Burton JI et al. The prevalence of acne
vulgaris in adolescence. Br J Dermatol1971:
85: 119-26
3. J. A. Cotterill et al. (1972): Age and Sex
variation in skin surface lipids Br J
Derm87/333 - 340.
4. Cunliffe WJ et al. Growth of cutaneous
propionibacteria on synthetic medium. J
ApplBacteriol 1979; 47: 383-94
5. Burton JL et al. Lactation, Sebum excretion
and melanocyte stimulating hormone. Nature
1973; 243: 249 - 50.
6. Cunliffe HJ. The use of a corticosteroid
cream for immediate reduction in the clinical
sign of acne vulgaris. ActaDermVenereol
1989; 69: 452-3
7. Balknap BS. Et al. Treatment of acne with
5% benzoyl peroxide gel or 0.05% retinoic
acid cream. Cutis. 23 (6): 856-9, 1979

36 Int J Int Med Res. 2016; 3(3):33-36 e ISSN: 2393-9869 p ISSN: 2350-0360