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

In a panel discussion session at the 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 acne 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.1

“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 AAD 2025, view our latest conference coverage.

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.

References

1. Valisure Detects Benzene in Benzoyl Peroxide. Valisure. March 6, 2024. https://www.valisure.com/valisure-newsroom/valisure-detects-benzene-in-benzoyl-peroxide. Date accessed: March 10, 2025.