Christopher G. Bunick, MD, PhD

American Academy of Dermatology (AAD) Annual Meeting

 in Orlando, the title of which was ‘Acne and Rosacea,’ a portion of this discussion regarding controversies and misunderstandings in 

 and rosacea treatment was presented by Christopher Bunick, MD, PhD.

Bunick, who is known for his work as a Yale School of Medicine associate professor in dermatology, spoke on a variety of information related to treatments for these inflammatory conditions as well as the recent benzene and benzoyl peroxide controversy.

Acne and Rosacea Treatment Controversies, with Christopher Bunick, MD, PhD

“The session was being put together by the Academy, and they invited me to come talk about the role of benzene in consumer products, particularly benzol peroxide products, because that was a hot topic last year at the American Academy of Dermatology meeting and I thought that this was be a good forum,” Bunick said. “This particular session would be a good forum to talk a little bit more in depth about putting into perspective benzene in not just benzoyl peroxide, but other consumer products in dermatology, and give the audience a real feel for you know, what's real? What are rumors? Where's the research?”

Bunick responded to such rumors, going through some of the major takeaways covered in his talk on acne and rosacea.

“I think that one of the most important things is to understand the most recent paper published in the Journal of Investigative Dermatology,” Bunick said. “What that paper did is it looked at a couple things that I think are highly relevant to everyday practice. The first is that it looked at benzoyl peroxide products right off the store shelf at room temperature. It showed that about a third of all products that our patients and consumers can access had elevated benzene levels that were above the 2 parts per million conditional limit set by the US Food and Drug Administration. Either we follow the regulations of the FDA or we don't. It's a completely separate question from health risk.”

Bunick added that, in this case, when one has an expiration date on a product, such a product should be stable over the entire course of that expiration date. Otherwise, Bunick explained, these products would not be stable.

“One of the things that we did in our study, in addition to just looking at room temperature products, is to ask what happens if you take a benzoyl peroxide product, and in this case we used an encapsulated benzoyl peroxide product approved for rosacea, and we examined that product under accelerated heat temperatures to 50 degrees Celsius and at refrigerator temperatures 2 degrees Celsius. We found that the rate of benzene formation was significantly minimized at refrigerator temperature. So this has led me in my practice to advise all my patients to keep their benzoyl peroxide products stored at refrigerator temperatures.”

Bunick noted that recent studies suggesting a lack of danger with regard to benzene have a variety of limitations, noting that one may not necessarily know the amount of benzoyl peroxide applied over the body surface area, the concentration, instrumentation, or sensitivity of that instrumentation to detect benzene levels.

“Those questions are essential to answering some of these more health-related questions, and that's where I actually exercise and would ask everyone else to exercise caution,” Bunick said. “It's a few epidemiology studies that don't add up to meaning there's no risk. What it does mean is that we need continued, thoughtful, rigorous investigation into the long-term health implications of these exposures.”

For more information on this topic, view Bunick’s full interview video posted above this summary. To find out more from 

The quotes used in this video summary were edited for clarity. Bunick’s disclosures include the following: Consultant (Fees): AbbVie, Almirall, Apogee Therapeutics, Arcutis Biotherapeutics, Botanix Pharmaceuticals, Eli Lilly, LEO Pharma, LiVDerm, Pfizer, Regeneron, Takeda Pharmaceuticals, Teladoc Health; Advisory Board (Fees/Honoraria): Almirall, Dermatology Times, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Sanofi, South Beach Symposium, Takeda Pharmaceuticals, UCB; Investigator (Grants/Research Funding): AbbVie, Almirall, Daiichi Sankyo, Ortho Dermatologics, Palvella Therapeutics, Sun Pharmaceutical Industries, Timber Pharmaceuticals.

Valisure Detects Benzene in Benzoyl Peroxide. Valisure. March 6, 2024. 

https://www.valisure.com/valisure-newsroom/valisure-detects-benzene-in-benzoyl-peroxide

Videos

This interview features a discussion with Christopher Bunick, MD, PhD, regarding recent controversies in acne and rosacea related to benzene and benzoyl peroxide.

Emerging Treatments for Atopic Dermatitis

Video content above is prompted by the following:

Are there any ongoing atopic dermatitis studies or emerging therapies that you are excited about?

What advice would you like to share with clinicians taking care of patients with moderate/severe atopic dermatitis?

Recent advancements in atopic dermatitis research have focused on novel therapies and ongoing clinical trials. Emerging treatments, such as biologics and small molecules, are showing promise in managing moderate to severe cases. Clinicians are advised to stay informed about these developments to optimize patient care. Emphasizing a personalized approach, considering patient-specific factors, and maintaining open communication with patients are crucial. Additionally, integrating new therapies with existing treatment regimens can enhance outcomes. Continuous education and collaboration with specialists are essential for improving management strategies in atopic dermatitis.

Looking to the future of atopic dermatitis treatment, the panel discusses ongoing research and promising emerging therapies. 

Treatment of Bio-Naïve Patients or Those Progressing on Topical or Biologic Atopic Dermatitis Therapy

A bio naïve patient with moderate atopic dermatitis?

A patient whose disease is continuing to progress on topical treatments?

In managing atopic dermatitis, treatment strategies vary based on patient history and disease progression. For a bio-naïve patient with moderate atopic dermatitis, initial treatment typically involves topical therapies, including corticosteroids and calcineurin inhibitors. If the disease progresses despite topical treatments, systemic therapies or phototherapy may be considered. For patients not responding to biologic therapy, switching to an alternative biologic or incorporating adjunctive treatments may be necessary. Treatment plans should be individualized, considering patient-specific factors and potential side effects, to optimize therapeutic outcomes and improve quality of life.

Focusing on clinical scenarios, experts on atopic dermatitis discuss how their treatment approaches vary depending on patient-specific factors.

Use of JAK Inhibitors and Systemic Treatments for Atopic Dermatitis

How widely are clinicians using targeted agents that have become available over the last few years?

Where do you place JAKi vs biologics in the treatment of atopic dermatitis?

When during patient’s treatment journey would you recommend use of JAK inhibitors to your patients?

Who is an ideal candidate for JAKi use in atopic dermatitis?

The integration of targeted agents, including JAK inhibitors (JAKi), in clinical practice for atopic dermatitis has been increasing. Clinicians are evaluating the positioning of JAKi relative to biologics, considering factors such as efficacy, safety, and patient-specific characteristics. JAK inhibitors are often recommended for patients who have not responded adequately to topical treatments or biologics. Ideal candidates for JAKi are those with moderate to severe atopic dermatitis, particularly when rapid symptom control is needed or when other systemic therapies are contraindicated or ineffective.

Dermatologists outline the role of targeted therapies and JAK inhibitors in the treatment of patients with atopic dermatitis.

Christopher G. Bunick, MD, PhD

Articles