If we’re talking acne treatments, benzoyl peroxide is the real deal: doctors have been using this drug to manage acne since the 1960s. Today, benzoyl peroxide skincare is available in both OTC and prescription formulations — which leads to an obvious question: which option works best?

Read on for everything you need to know about over-the-counter vs. prescription benzoyl peroxide.

What is benzoyl peroxide?

A quick recap on how this antimicrobial wonder works: benzoyl peroxide kills C. acnes bacteria on contact. It’s oil soluble, like salicylic acid, which means it’s able to readily penetrate into pores — where it mixes with trapped sebum and dead skin cells.

Then the magic happens: as the compound breaks down, it releases oxygen. All you amateur skincare scientists out there know what this means: chemically speaking, it’s free radical production. Which is bad news for C. acnes, because it thrives in an anaerobic (read: oxygen free) environment.

What’s the difference between OTC and prescription benzoyl peroxide?

Though manufacturers have been selling (and doctors prescribing) benzoyl peroxide for decades to treat acne, it wasn’t until 2011 that the FDA officially ruled the ingredient GRASE (Generally Recognized As Safe and Effective) for use in over-the-counter acne products. Today, the ingredient is available without a prescription in a variety of preparations — like cleansers, lotions and gels — ranging in concentration from 2.5% to 10%.

According to board certified dermatologist Dr. Sandra Lee (aka Dr. Pimple Popper), strengths higher than 10% benzoyl peroxide tend to be too drying for patients — so OTC options are the best first-line treatment for most cases of inflammatory acne. Her product recommendations include:

• Benzoyl Peroxide Acne Lotion: part of the SLMD Acne System
• BP Acne Spot Treatment: maximum strength pimple treatment
• BP Body Wash: part of the SLMD Body Acne System

If you don’t see results after about three months of a consistent acne regimen (like SLMD Acne System), it’s time to pay a visit to your dermatologist.

Is benzoyl peroxide available by prescription?

Although maximum-strength OTC benzoyl peroxide is highly effective in treating inflammatory breakouts, dermatologists do prescribe it on a case-by-case basis. BP is sometimes prescribed as a body wash for patients with inflammatory body acne. A dermatologist might also recommend it in combination with other drugs, including:

• Tretinoin/benzoyl peroxide: approved by the FDA in 2021 for the treatment of acne, brand name Twyneo
• Benzoyl peroxide/clindamycin: approved in 2000, brand name Benzaclin, generic and other brands available
• Adapalene/benzoyl peroxide: approved in 2008, brand name Epiduo, generic just became available in 2021

Anyone in-the-know about retinoids may be surprised to see any type of vitamin A derivative combined with benzoyl peroxide — since historically, studies have shown that BP makes retinoids less effective. But more recent studies indicate that this may not be the case, after all — though the debate continues. For now, Dr. Lee suggests that patients continue to alternate products: use benzoyl peroxide in the morning, and retinol at night, to avoid any possible interactions.

Dr. Lee’s last word

For patients with inflammatory acne, benzoyl peroxide is really a game-changer — especially when combined with other acne-fighting ingredients like in my Acne System. It kills C. acnes bacteria and you don’t need a prescription from your dermatologist, which makes it widely accessible for everyone. Now it may cause some irritation, so don’t forget to use a non occlusive moisturizer and a sunscreen every day.

—Dr. Sandra Lee