A generic BPO does not work the same way as the novel solubilized BPO applied in Obagi medications. This 5% BPO gel in conjunction with a salicylic acid-based toner resulted in a greater reduction in the non-inflammatory lesion count than twice-daily applications of a prescription 5% benzoyl peroxide/antibiotic product (34% v. 21% after 2 weeks). Although these results are not groundbreaking, the study conducted by Mary C. Spellman, MD (San Francisco, CA) and Jose Ramirez, PhD (JR Chemical, Milford, CT) shows that the solution is especially potent against Propionibacterium acnes and its comedolytic activity.
Nevertheless, physicochemical challenges in the formulation of BPO products mean that the bioavailability of BPO and its ability to enter follicles (and so act directly at the pathogenic source of acne) may be significantly compromised. For example, it is thought that only a very small proportion of available BPO molecules in commercially successful BPO formulations are actually delivered to the follicles. It is possible therefore that improving the bioavailability of BPO, and improving delivery to the follicles, could enhance the clinical efficacy of BPO still further.
A number of factors are believed to hinder the delivery of BPO to the follicles. First, BPO molecules are poorly soluble. Second, they aggregate into clusters that may be large enough to prevent them even entering the follicles—an evaluation of three commercially available BPO products showed that the BPO clusters in the formulations had diameters of 5-50 μm, 10-100 μm, and 50-100 μm, respectively, whereas an average hair follicle has a diameter of approximately 50 μm.
Clustering also inhibits the action of the BPO because most of the BPO molecules become trapped in the interior of a cluster, hindering their ability to interact with P. acnes. A third factor that can impact the delivery of BPO to the follicles is the vehicle—for example, BPO formulations may be oil in water emulsions and these do not readily flow into follicles.
In the past, attempts to use various solvents to improve the solubility of BPO were thwarted because increasing the solubility of BPO was found to negatively impact its stability. However, more recently, a novel solubilized 5% BPO gel has been developed that is designed to deliver superior BPO solubility without any such stability problems. Based on the results of comparative trials [Erianne J, Prince DL, Ramirez J, Wilson D, Zeichner J., “The pharmacologic science of a novel benzoyl peroxide formulation and the implications for clinical effects,” presented at the 25th Anniversary Fall Clinical Dermatology® Conference, October 6-9, 2006, Las Vegas, NV.] the bioavailability of BPO in this novel solubilized BPO gel is thought to be substantially higher than that in other commercially available formulations. In addition, the vehicle is designed to allow the passage of BPO into the follicles.
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