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All Journal The International Journal of Medical Science and Health Research The Indonesian Journal of General Medicine
Auliani Deby Veronica
Faculty of Medicine, Sebelas Maret University, Indonesia
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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The Comprehensive Systematic Review of Use of Benzoyl Peroxide as Monotherapy or Combination Therapy for Acne Auliani Deby Veronica; Deriel Elka Hidayat
The International Journal of Medical Science and Health Research Vol. 48 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/htwn1y81

Abstract

Introduction: Acne vulgaris is a prevalent inflammatory skin condition. Benzoyl peroxide (BPO) is a first-line topical agent, but the comparative efficacy of monotherapy versus combination regimens remains to be systematically defined. This review evaluates the significant positive clinical outcomes of BPO as monotherapy or combination therapy. Methods: A systematic screening of randomized controlled trials and vehicle-controlled studies was performed. Inclusion criteria: patients with acne vulgaris, BPO as active intervention, comparator group, and quantifiable outcomes. Data extraction focused on lesion count reductions, treatment success rates, safety, and comparative effectiveness. Results: From 80 included studies (29,592 participants), BPO monotherapy demonstrated significant superiority over vehicle: inflammatory lesion reduction 52.1% vs 34.7% and total lesion reduction 44.3% vs 27.8% (p<0.001) (1). Adapalene 0.1%/BPO 2.5% combination showed significant synergy, achieving 78.4% total lesion reduction vs BPO 52.6% (p<0.05) (8). The triple combination clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% (CAB) yielded treatment success rates of 51.3% vs adapalene 0.3%/BPO 2.5% 32.9% (p<0.001) (13). Inflammatory lesion reductions exceeded 75% with CAB (11,38). Adapalene 0.3%/BPO 2.5% reduced atrophic scar count by 21.7% at week 24 (p<0.0001 vs vehicle) (65). Safety profile showed mild-to-moderate local reactions; no serious BPO-related adverse events. Discussion: BPO monotherapy provides significant efficacy in mild-to-moderate acne. Combination therapies, particularly with adapalene or clindamycin, yield superior outcomes due to synergistic mechanisms. The triple combination CAB gel represents a significant advance for moderate-to-severe acne. However, most CAB evidence comes from industry-sponsored trials. Conclusion: BPO monotherapy is effective for mild acne. Combination therapy, especially with retinoids or antibiotics, is significantly more effective for moderate-to-severe disease. The triple combination offers the highest efficacy.
The Comprehensive Systematic Review of Effectiveness of Salicylic Acid in Chemical Peeling Procedures for Comedonal Acne Auliani Deby Veronica; Deriel Elka Hidayat
The International Journal of Medical Science and Health Research Vol. 48 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/1btjx557

Abstract

Background: Comedonal acne is characterized by open and closed comedones and often requires effective keratolytic agents. Salicylic acid (SA), a lipophilic beta-hydroxy acid, is widely used in chemical peels, but comprehensive systematic evidence focusing specifically on comedonal outcomes is limited. Methods: This systematic review analyzed 52 studies, including randomized controlled trials, and comparative cohort studies. The primary outcome was comedone-specific reduction following SA chemical peels. Secondary outcomes included overall acne improvement, safety, tolerability, and comparison with other peeling agents. Results: Six biweekly sessions of 30% SA peels achieved consistent comedone reductions of 88–90% (p<0.001) (1,2). The salicylic-mandelic acid combination (20% SA + 10% mandelic acid) produced 90.2% comedonal clearance, significantly superior to 35% glycolic acid (35.87%) (5). SA 30% was significantly more effective than Jessner’s solution for non-inflammatory lesions (p=0.04) (4) and superior to 25% TCA in one study (69% vs. 60% reduction, p<0.001) (11), though another found equivalence (6). Combination therapies enhanced outcomes: SA peel plus pulsed dye laser showed greater improvement than SA alone (p=0.003) (7); adding SA peels to oral isotretinoin increased clearance from 73.4% to 92.5% (9). Safety was favorable: transient burning and erythema were common but self-limiting; no serious adverse events were reported. SA peels showed better tolerability than TCA and mandelic acid peels (6,16,40). Discussion: The lipophilic property of SA enables deep follicular penetration, explaining its superior comedolytic effect. Protocol variations (session frequency, outcome measurement) explain the reported heterogeneity (54–90%). The 6-session biweekly regimen appears optimal. Conclusion: Thirty percent salicylic acid peels administered biweekly for six sessions are highly effective, safe, and well-tolerated for comedonal acne, achieving approximately 90% comedone reduction. SA is superior or equivalent to most superficial peeling agents for comedones.
Effectiveness of Oil-Based Facial Cleansers (Oil Cleansing) for Acne-Prone Skin : A Systematic Review Auliani Deby Veronica; Deriel Elka Hidayat
The Indonesian Journal of General Medicine Vol. 40 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8srct432

Abstract

Introduction: Oil cleansing is a popular skincare practice for acne-prone skin, yet the clinical efficacy of oil-based formulations remains unclear due to heterogeneous evidence. This systematic review evaluates the effectiveness of topical oil-containing products on acne outcomes. Methods: A systematic search was performed following PRISMA guidelines. Human clinical studies evaluating oil or essential oil-containing topical formulations for acne vulgaris with at least 2 weeks duration were included. Primary outcomes were lesion count reduction, acne severity scores, and inflammatory markers. Results: The double-blind RCT by Infante et al. (2023) demonstrated that tea tree oil nanoemulsion significantly reduced comedone count (p<0.001) and improved follicular hyperkeratinization. Da Silva et al. (2012) reported copaiba essential oil gel significantly decreased acne-affected surface area (r²=0.695, p=0.000). Mazzarello et al. (2020) showed myrtus and origanum essential oils combined with tretinoin reduced erythema superior to clindamycin-tretinoin (p=0.0329). Meier et al. (2012) found jojoba oil clay mask achieved 54% total lesion reduction (p<0.05 for all lesion types). Kim et al. (2018) reported myrtle essential oil regimen reduced acne grade from 1.8 to 0.9 (p=0.001). Nong et al. (2023) demonstrated bakuchiol-containing regimen reduced total facial lesions by 25.2% (p<0.05). Secondary outcomes included significant sebum reduction and improved hydration. Safety was favorable with minimal irritation. Discussion: The most robust evidence supports tea tree oil nanoemulsion, copaiba oil, and myrtle essential oil. Formulation delivery system critically determines efficacy. Study quality varies; placebo-controlled RCTs show significant but modest effects. No evidence exists for pure oil cleansing method. Conclusion: Oil-containing formulations, particularly with tea tree, copaiba, or myrtle oils in optimized vehicles, demonstrate significant efficacy for mild-to-moderate acne. Advanced delivery systems enhance outcomes. Pure oil cleansing lacks evidence.
Co-Authors Deriel Elka Hidayat