In this episode of Topical Conversations, John Barbieri, MD, MBA, FAAD, shares his updated thoughts on the Valisure report findings from March 2024, which identified potentially harmful levels of benzene in benzoyl peroxide-containing products, particularly those exposed to high temperatures. 

Call for transparency and FDA input 

Dr Barbieri expressed the medical community's need for more detailed information from Valisure and guidance from the FDA. He highlighted the importance of updated data to determine whether benzoyl peroxide products remain safe for consumer use. The lack of conclusive data has left health care professionals seeking clarity to make informed decisions for their patients. 

Approach to patient care 

In the absence of more comprehensive data from Valisure and definitive input from the FDA, Dr Barbieri shared his approach to managing the potential risks in clinical practice. He referenced 2 recent studies that provide some reassurance regarding the safety of benzoyl peroxide products: One study analyzing blood benzene levels demonstrated that individuals using benzoyl peroxide-containing products do not exhibit elevated benzene levels in their blood compared to nonusers. Another cohort study on cancer risk found no increased risk of leukemia, lymphoma, or other cancers among users of benzoyl peroxide products compared to those who do not use these products. 

Dr Barbieri found these results reassuring, indicating that routine use of benzoyl peroxide-containing products does not appear to pose the risks of cancer or elevated benzene levels that might be expected. 

Understanding benzene exposure risks 

Dr Barbieri explained the general principles of toxicology, noting that "the dose makes the poison." Benzene, a known carcinogen, is not significantly absorbed through the skin, making topical exposure unlikely to cause major risks such as skin cancer. He provided a comparative analysis of benzene exposure, explaining that even the worst-case scenario product tested by Valisure, with 10 parts per million of benzene, would result in about 10 micrograms of exposure from a typical 1-gram application. He compared this to the everyday benzene exposure from a gas stove, which emits about 5 micrograms of benzene per minute. This comparison suggests that the theoretical risk from benzoyl peroxide products is minimal compared to common everyday exposures. 

Practical advice and continued use in clinical practice 

Dr Barbieri continues to use benzoyl peroxide products in his practice. He advises patients to store these products properly and emphasizes the importance of considering the supply chain to minimize heat exposure during transit. 

Awaiting further guidance 

Dr Barbieri concluded by expressing a need for ongoing input from the FDA to provide clearer guidelines on the safety of benzoyl peroxide products. In the meantime, he believes that with appropriate storage and usage, these products can be used safely, supported by current data and practical considerations.