Topical Benzoyl Peroxide (2.5–10%)

Purpose & Scope

This policy standardises how our clinic initiates and monitors topical benzoyl peroxide at 2.5–10% for mild to moderate acne on the face and trunk. ⁵ ⁴ It explains practical dosing, titration, counselling and escalation so clinicians and support staff give consistent instructions aligned to Australian regulatory information and mainstream guidelines. ¹ ⁵ Benzoyl peroxide is a non‑prescription medicine in Australia and remains a cornerstone of acne care because it is effective, low cost and does not drive antimicrobial resistance. ¹ ⁸

Regulatory Status & Preparations (Australia)

BENZAC AC 5% gel is listed on the ARTG under Non‑Prescription Medicines with the specific indication 'Treatment of acne'. ¹ BENZAC AC 10% gel is likewise a Non‑Prescription Medicine with the specific indication 'Treatment of acne'. ² Scheduling can vary by strength and pack size, with some 5% gel packs recorded as Not Scheduled and 10% gel packs recorded as S2 Pharmacy Medicine. ¹ ² A 5% benzoyl peroxide wash is registered for the treatment of mild to moderate acne and is also a Non‑Prescription Medicine. ³ Available strengths commonly include 2.5%, 5% and 10% in gels, creams and washes, and fixed‑dose combinations are marketed in some settings. ⁴ ⁵

How It Works

Benzoyl peroxide is an oxidising agent with antibacterial, comedolytic and anti‑inflammatory actions that reduce Cutibacterium acnes and help clear blocked follicles. ⁴ It does not promote antimicrobial resistance and helps reduce resistance when used alongside topical or oral antibiotics. ⁸ ⁵ These mechanisms make it useful across inflammatory and comedonal acne and valuable in antibiotic‑stewardship based regimens. ⁵ ⁷

Before You Start (Selection, Baselines)

Choose benzoyl peroxide when a non‑prescription, resistance‑sparing option is preferred or when patients have struggled with irritation from other topicals. ⁸ ⁴ It suits adolescents and adults and can be used on the trunk where washes or gels may be easier to apply. ³ ⁴ Record baseline photos, current skincare and prior reactions to acne products to anticipate tolerance and select the starting strength. ⁹ ⁴ Explain that improvement is gradual and that irritation is common at the start but usually settles with moisturiser and titration. ⁹ ⁴

How to Apply (Clear, Stepwise)

Cleanse with a mild, non‑soap cleanser then pat completely dry before application. ⁹ ⁴ Start with 2.5% or 5% once daily as a thin film to the entire affected area rather than spot‑treating only visible lesions. ⁹ ⁵ For sensitive skin, consider short‑contact therapy first by applying once daily, leaving for about one to two hours, then rinsing and moisturising for several days before leaving on overnight. ⁹ ⁵ If tolerated after several days, leave on overnight and, if needed, build to twice‑daily use. ⁹ ⁵ Use a non‑comedogenic moisturiser to reduce stinging and dryness and apply SPF 50+ each morning. ⁴ ⁵ Avoid the eyes, lips, corners of the nose and broken skin, and wash hands after application. ⁹ ⁴ Advise that benzoyl peroxide can bleach hair, towels and clothing and that products should dry fully before contacting fabrics. ⁹ ⁴

What to Expect (Timelines and Outcomes)

Most people notice fewer inflamed spots and less oiliness after four to eight weeks of regular use with best results after a full 12‑week course. ⁵ ¹⁰ Effectiveness is supported by systematic reviews and by a large network meta‑analysis showing benzoyl peroxide‑containing regimens among effective first‑line options. ¹⁰ ¹¹ If there is little or no improvement after 12 weeks, review adherence, technique and combination options or escalate per guideline pathways. ⁵

Evidence Summary (Readable)

Cochrane review evidence indicates benzoyl peroxide improves acne compared with vehicle with acceptable tolerability in short‑term trials. ¹⁰ A 2022 network meta‑analysis across topical and combination therapies supports benzoyl peroxide‑containing regimens among effective first‑line options. ¹¹ ⁵ Recent guidelines make consistent recommendations for benzoyl peroxide as part of first‑line therapy and for maintenance when retinoids or antibiotics are unsuitable. ¹² ⁵ Guidelines also emphasise 12‑week initial courses and review for optimisation or escalation. ⁵ ⁶

Combinations and Regimens

For mild to moderate acne, combine a nighttime retinoid with morning benzoyl peroxide or use a fixed‑dose combination such as adapalene with benzoyl peroxide. ⁵ If topical or oral antibiotics are used, avoid monotherapy and always pair with benzoyl peroxide to reduce resistance. ⁵ ⁸ When irritation occurs with combinations, space applications morning and night or alternate days until the skin adapts. ⁹ ⁴ For truncal acne, a benzoyl peroxide wash can be used as field therapy with leave‑on gel for persistent lesions. ³ ⁴

Safety & Tolerability

Common effects include stinging, burning, erythema, dryness and peeling which usually improve with moisturiser or reduced frequency. ⁹ ⁴ Allergic or irritant contact dermatitis can occur and patients should stop and reassess if marked swelling or rash develops. ⁴ ⁹ Benzoyl peroxide can bleach hair, towels and clothing so advise allowing products to dry fully and take care with pillowcases and collars. ⁹ ⁴ Counsel on sun protection and on pausing and re‑introducing slowly if irritation flares. ⁹ ⁴

Patient Counselling that Sticks

Keep the routine simple: cleanse, benzoyl peroxide, moisturiser and sunscreen in the morning and cleanse, benzoyl peroxide and moisturiser at night. ⁴ ⁵ Use fragrance‑free products and avoid scrubs, harsh toners or peels in the first weeks. ⁴ ⁹ Explain that stronger is not always better because many patients tolerate 2.5–5% better than 10% with similar outcomes. ⁴ ¹⁰ Encourage adherence for the full 12‑week course before judging efficacy. ⁵ ⁶

Monitoring and Escalation

Review at eight to twelve weeks to check adherence, technique and adverse effects. ⁵ ⁷ If response is suboptimal, consider adding a retinoid, switching to a fixed‑dose combination or adding an appropriate oral agent per severity and guideline advice. ⁵ ¹² Avoid prolonged antibiotic use and never use topical or oral antibiotic monotherapy in acne. ⁸ ⁵

Storage & Handling

Benzac AC gels list storage below 25 °C on their TGA public summaries. ¹ ² Benzac AC 5% wash lists storage below 25 °C with an 18‑month shelf life. ³ Advise patients to recap tubes promptly and discard very old or heat‑exposed products. ⁹ ⁴

Quick‑Reference Instructions for Patients

Wash with a gentle cleanser and wait a few minutes until fully dry. ⁹ Apply a thin layer of 2.5% or 5% to the whole affected area once daily for several days. ⁹ ⁵ If comfortable, leave on overnight and increase to twice daily as needed. ⁹ ⁵ Moisturise after application and use SPF 50+ every morning. ⁴ ⁵ Keep away from eyes and fabrics and expect gradual improvement over weeks rather than days. ⁹ ⁴

Sources

Therapeutic Goods Administration (TGA) 2025, Public Summary for ARTG Entry: 25271 — BENZAC AC 5% benzoyl peroxide 50 mg/g gel (PDF), Department of Health, viewed 11 Nov 2025., viewed 20 November 2025, https://www.ebs.tga.gov.au/servlet/xmlmillr6?actionid=1&agid=(PrintDetailsPublic)&dbid=ebs/PublicHTML/pdfStore.nsf&docid=25271 ↩
Therapeutic Goods Administration (TGA) 2025, Public Summary for ARTG Entry: 25268 — BENZAC AC 10% benzoyl peroxide 100 mg/g gel (PDF), Department of Health, viewed 11 Nov 2025., viewed 20 November 2025, https://www.ebs.tga.gov.au/servlet/xmlmillr6?actionid=1&agid=(PrintDetailsPublic)&dbid=ebs/PublicHTML/pdfStore.nsf&docid=25268 ↩
Therapeutic Goods Administration (TGA) 2025, Public Summary for ARTG Entry: 52350 — BENZAC AC WASH 5% benzoyl peroxide 50 mg/g application bottle (PDF), Department of Health, viewed 11 Nov 2025., viewed 20 November 2025, https://www.ebs.tga.gov.au/servlet/xmlmillr6?actionid=1&agid=(PrintDetailsPublic)&dbid=ebs/PublicHTML/pdfStore.nsf&docid=52350 ↩
DermNet NZ 2025, Benzoyl peroxide — uses, dosing, precautions and bleaching, viewed 11 Nov 2025., viewed 20 November 2025, https://dermnetnz.org/topics/benzoyl-peroxide ↩
NICE 2021 (reviewed 2023), NG198 Acne vulgaris: management — Recommendations, viewed 11 Nov 2025., viewed 20 November 2025, https://www.nice.org.uk/guidance/ng198/chapter/recommendations ↩
NICE 2021, NG198 Acne vulgaris: management — Evidence and maintenance rationale (PDF), viewed 11 Nov 2025., viewed 20 November 2025, https://www.nice.org.uk/guidance/ng198/resources/acne-vulgaris-management-pdf-66142088866501 ↩
RACGP 2017, Acne in adolescents — antibiotic stewardship and combinations, viewed 11 Nov 2025., viewed 20 November 2025, https://www.racgp.org.au/afp/2017/december/acne-in-adolescents ↩
Choosing Wisely Australia (ACD) 2020, Do not use antibiotic monotherapy for acne; combine with benzoyl peroxide or retinoid, viewed 11 Nov 2025., viewed 20 November 2025, https://www.choosingwisely.org.au/recommendations/acd5 ↩
NPS MedicineWise 2011, Benzac AC Gel — Consumer Medicine Information (MIMS/myDr PDF), dosing and precautions including bleaching of fabrics, viewed 11 Nov 2025., viewed 20 November 2025, https://www.nps.org.au/assets/medicines/27f5e7c0-f32d-4221-8e54-a53300ff60f6.pdf ↩
Cochrane 2020, Topical benzoyl peroxide for acne — review summary, viewed 11 Nov 2025., viewed 20 November 2025, https://www.cochrane.org/evidence/CD011154_topical-benzoyl-peroxide-acne ↩
Mavranezouli I et al. 2022, Systematic review and network meta‑analysis of acne treatments, British Journal of Dermatology (Open Access), viewed 11 Nov 2025., viewed 20 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9804728/ ↩
Reynolds RV et al. 2024, Guidelines of care for the management of acne vulgaris, Journal of the American Academy of Dermatology (PubMed record), viewed 11 Nov 2025., viewed 20 November 2025, https://pubmed.ncbi.nlm.nih.gov/38300170/ ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.