DOI: 10.14457/tu.the.2018.720
title: Clinical comparison between topical 2.5% benzoyl peroxide +5% niacinamide and 2.5% benzoyl peroxide in the treatment of mild to moderate facial acne vulgaris

description: Acne vulgaris is a common multifactorial inflammatory disease affecting the pilosebaceous units of the skin found commonly in dermatology outpatient departments. The major pathogenic factors involved are increased sebum production, follicular hyperkeratinization which leads to obstruction of sebaceous follicles, colonization of pilosebaceous units by Propionibacterium acnes, and perifollicular inflammation. An old and well-known topical treatment is benzoyl peroxide, which is an antibacterial agent that kills Propionibacterium acnes through the release of free oxygen radicals and it is also mildly comedolytic. When combined with a new topical therapy, topical niacinamide, which is an amide of vitamin B-3 and has an anti-inflammatory effect, reduces facial sebum production, and it also has a skin lightening effect. This combined treatment can lead to better efficacy in the treatment of facial acne vulgaris. Further, it can also help in post acne erythema and post inflammatory hyperpigmentation.The present study aims to investigate the efficacy of a new topical drug combined with an old topical therapy (5% niacinamide plus 2.5% benzoyl peroxide) in patients with acne vulgaris. The study also seeks to observe the side effects of this combination. Seventeen patients with mild to moderate acne vulgaris were included in the study, with a mean age of 26. The study was a randomized, intraindividual, double-blinded controlled trial. The treatment was randomly assigned to the left or the right side of the face for individual participants. One side received topical 2.5% benzoyl peroxide + 5% niacinamide, while the other side received only topical 2.5% benzoyl peroxide for a period of 12 weeks. The efficacy was evaluated by using lesion counts, sebum casual level by Sebumeter®, post acne erythema, and post inflammatory hyperpigmentation by ANTERA3D camera®. At week 12, the niacinamide group (5% niacinamide + 2.5% benzoyl peroxide) showed significant reductions to both acne lesion count and sebum casual levels from the baseline (p=0.000 and p=0.001, respectively). The reduction of non-inflammatory lesions count in the niacinamide group was better than the cream base group (2.5% benzoyl peroxide + cream base) with a statistically significant difference (p=0.004). Yet the reduction of inflammatory lesions was not significantly different between the two groups. Interestingly, the sebum casual level in the niacinamide group reduced faster than for the cream base group. The post acne erythema score reduced from the baseline for both groups with no statistically significant difference within and between the two groups. The post inflammatory hyperpigmentation scores from acne showed increases for both groups above the baseline with a statistically significant difference in the cream base group (p = 0.000) and not significant difference in the niacinamide group (p = 0.58), but there was no statistically significant difference between the two groups. Furthermore, there were no statistically significant differences found between the two groups at every follow-up visit in terms of physician improvement scale, patient satisfaction index, and side effects.The combination of 2.5% benzoyl peroxide with 5% niacinamide is found to be more effective in the treatment of mild to moderate facial acne vulgaris, since it was found to reduce non-inflammatory lesions and more quickly improve non-inflammatory lesions and facial sebum reduction compared to 2.5% benzoyl peroxide with a cream base. It also had minimal side effects. However, the efficacy of 2.5% benzoyl peroxide with 5% niacinamide at treating inflammatory lesions, post acne erythema, and post-inflammatory hyperpigmentation is comparable to 2.5% benzoyl peroxide with a cream base.