Is benzoyl peroxide compatible with sun exposure?

A photosensitizing substance is a substance that increases or alters the skin's sensitivity to light, particularly UV rays. It can be either toxic in nature or allergenic in nature.

• Photoallergic substances are compounds that, after exposure to light, can sensitize the immune system, leading to an allergic skin reaction. Symptoms may include skin flaking, skin irritation, and eczema. Photoallergic reactions appear after a sensitization phase, on areas exposed or not exposed to the sun, and can persist over time. These reactions can be triggered by a hereditary predisposition and exposure to the substance.

• A phototoxic substance is a compound that causes immediate skin damage when exposed to light. This means that the adverse reaction results from the direct interaction between the substance and light. When photoreactive substances absorb UV and visible light, their energy level increases and they dissociate to produce reactive oxygen species (ROS). These ROS are the primary agents responsible for phototoxicity, as their accumulation leads to cell damage or destruction.

  Furthermore, oxidative stress caused by ROS damages DNA, lipids, and proteins, thereby affecting the health of skin tissues. This reaction results in immediate adverse effects, such as red patches, sunburn-like burns, erythema, or hyperpigmentation. Phototoxic reactions do not affect skin that is not exposed to the sun and disappear as soon as the treatment is stopped. In the long term, phototoxicity could potentially increase the risk of developing skin cancer.

The severity of the reaction depends on the intensity of sun exposure, the medication, the administered dose, as well as the individual's skin phototype.

The benzoyl peroxide is a particularly effective agent for treating acne because it inhibits the bacteria responsible for skin inflammation. However, it has a molecular structure with chromophores, that is, a group of atoms containing one or more double bonds. Now, when a chromophore is exposed to light, its electrons get excited and absorb specific wavelengths, which elevates them to a higher energy level. This makes the molecule more reactive. It then interacts with the surrounding oxygen and, through molecular dissociation, induces the generation of ROS which are involved in the phototoxicity reaction. Some research indicates that benzoyl peroxide could be phototoxic because of its chromophores.

• In order to highlight the phototoxic potential of benzoyl peroxide, a study was conducted on 24 volunteers using a product containing 5% benzoyl peroxide. Photobiological tests and irradiations with UVA and UVB rays were carried out. The results showed that 33% of the subjects exhibited erythema, even though the UVB irradiation was less than the minimal erythema dose (MED), suggesting phototoxicity in response to UVB. On the other hand, no phototoxicity associated with UVA was observed in this analysis.

• A few years later, the same researchers conducted another study over 16 days, this time using a 10% benzoyl peroxide gel via a photopatch test (photoepidermotest). The results showed phototoxicity in 44% of the participants (8 out of 18), due to the appearance of erythema on the treated areas compared to the control areas with irradiation less than the MED.

• In 2004, a study published by the National Center for Biotechnology Information examined the impact of benzoyl peroxide gel and other substances on UVB-induced erythema. Out of 30 volunteers, the MED with or without the application of benzoyl peroxide was the same, suggesting a lack of influence on the risk of burning.

The conclusions of these three studies should be approached with caution as the limited number of volunteers and discrepancies between the study results do not allow for an accurate assessment of the risk frequency or definitive conclusions about the photosensitizing power of benzoyl peroxide.

Beyond its phototoxic action, the benzoyl peroxide is known for its exfoliating properties, which allow it to remove dead skin cells and promote cellular renewal. However, exfoliation can increase skin's sensitivity to light because when the top layer of skin is removed, it becomes more exposed and less protected against the harmful effects of UV rays. This could potentially intensify the photosensitizing reaction if benzoyl peroxide is used concurrently with light exposure. This is, however, a hypothesis, as no studies have shown a direct action of the exfoliating property of benzoyl peroxide on its photosensitive nature.

The possibility that benzoyl peroxide may be photosensitizing, and particularly phototoxic, cannot be ruled out. As a precautionary principle, it is therefore advised to apply it in the evening and to use sun protection the following morning.

Note : Any treatment or chemical potentially responsible for a photosensitive reaction should be discontinued. In many cases, the skin reaction gradually fades after the treatment is stopped, but this can vary from person to person depending on the severity of the reaction and individual sensitivity. Therefore, it is strongly recommended to consult a doctor at the first signs of symptoms. In some cases, topical corticosteroids may be prescribed to reduce inflammation and soothe the skin.

• CIVATTE J. & al. Research on the phototoxic power of 5% benzoyl peroxide in humans. Dermatologica (1983).

• CIVATTE J. & al. Prediction of benzoyl peroxide phototoxicity through photoepidermotests after repeated applications. The preventive value of a UVB filter. National Center For Biotechnology Information (1988).

• EDWARD M. Benzoyl Peroxide: An Old Drug with New Problems. Cutaneous and Ocular Toxicology (1996).

• EPSTEIN J. H. Phototoxicity and Photoallergy. National Center for Biotechnology Information (1999).

• OZKAN S. & et al. No phototoxic effects were detected from topical azelaic acid, benzoyl peroxide, and adapalene when applied immediately before UVB exposure to normal skin. National Center for Biotechnology Information (2004).

• KWON LEE J. & others. Evaluation of Phototoxicity of Pharmaceutical Substances with a Reactive Oxygen Species Assay Using Ultraviolet A. Official Journal of the Korean Society of Toxicology (2016).

• PAPP L. A. & et al. Photosensitivity Reactions Triggered by Photochemical Breakdown of Medications. Advanced Pharmaceutical Bulletin (2021).

• EURODERM. European Dermatology Guideline for Photodermatoses.

• RFPRCV. Medications and Photosensitivity.

• BOURRAIN J. L. Phototoxicity, photoallergy: diagnosis and management. Allergology-photobiological explorations, Dermatology, Multidisciplinary Medicine Pole, University Hospital of Grenoble.