Benzoyl peroxide helps kill bacteria in the skin without causing a lot of irritation. As a result, a doctor may recommend it for people with hidradenitis suppurativa (HS).

HS is an inflammatory skin condition that causes painful lesions in areas like the armpits, under the breasts, and in the groin. A bacterial overgrowth can contribute to the problem, so antibacterial products like benzoyl peroxide can be helpful. If you’re interested in adding benzoyl peroxide to your other medical treatments for HS, here’s what you should know.

What Is Benzoyl Peroxide?

Benzoyl peroxide is a medication that you can buy with or without a prescription. The U.S. Food and Drug Administration (FDA) has approved it as a treatment for acne and rosacea. Benzoyl peroxide works by penetrating the skin and killing a specific type of bacteria that’s found in the skin and hair follicles. It also reduces oil, but it can be drying if too much is used.

Benzoyl peroxide is available in different forms, including:

• Creams
• Lotions
• Gels
• Shaving creams
• Foams
• Soaps

Sometimes it’s combined with antibiotics or retinoids, making it more effective. It’s important to be careful about sun exposure when using benzoyl peroxide because it can make the skin more sensitive to ultraviolet light. In addition, you shouldn’t apply it to your eyes, mouth, or open wounds because it may cause intense irritation.

Side effects of benzoyl peroxide include:

• Mild dryness
• Swelling
• Scaling

It can also bleach or cause discoloration of colored fabrics and even hair.

Is There Evidence Benzoyl Peroxide Can Help With HS?

Although benzoyl peroxide is approved by the FDA only to treat acne and rosacea, doctors sometimes prescribe it off-label for other skin conditions, like folliculitis (infection or inflammation of the hair follicles) and pressure ulcers. Some research supports the use of benzoyl peroxide for HS, but there aren’t any large-scale or highly conclusive studies showing a benefit.

For example, one study compared the effects of topical clindamycin versus a combination of clindamycin and benzoyl peroxide. Clindamycin is a topical antibiotic that dermatologists commonly prescribe for HS. The study was small, with just 10 participants, who were followed for a total of 16 weeks. About half of the participants in each group responded well to the treatment they were given.

Researchers concluded that clindamycin by itself was just as effective as the combination treatment; however, not everyone saw an improvement. Many people with HS develop what’s called “antibiotic resistance,” which refers to bacteria in a person’s body changing to resist an antibiotic that was initially effective. Benzoyl peroxide can serve as a long-term treatment option, but it carries the risk of causing a person to develop antibiotic resistance.

Although benzoyl peroxide may offer benefits for keeping HS under control, it may not work for everyone. In addition, most people with HS require more than one type of treatment. Benzoyl peroxide body washes or creams may need to be combined with hormonal therapies (like oral contraceptives), oral antibiotics, biologics, laser hair removal, corticosteroids, and sometimes surgical procedures for more severe HS.

Tips From myHSteam Members

Most members of myHSteam who talk about benzoyl peroxide have positive things to say. “I wash with a benzoyl peroxide wash every night and use clindamycin and a steroid cream during flare-ups,” said one member.

Another shared, “I don’t know if this has helped others with the acne breakouts from HS, but I started using charcoal wash, salicylic acid wash, and benzoyl peroxide wash on my face. It cut down on the acne breakouts.”

Some members have discussed more specifically what percentage of benzoyl peroxide they use:

• “What I have found that works for me is applying clindamycin 1 percent to the affected area twice daily. I clean the bumps with benzoyl peroxide topical wash 5 percent, twice weekly for outbreaks.”
• “I might get the itching sensation when it’s time for my monthly, so I’ll rub some benzoyl peroxide 5 percent on the area.”
• “I will describe my routine, which I think reduces the number of flares. I take a shower in the morning with benzoyl peroxide (10 percent) soap. After my shower, I use clindamycin gel 2 percent on my face, groin, genitals, perianal area, and buttocks. If I do any activity that makes me sweat, especially in the groin, genitals, perianal area, or buttocks, I am sure to dry myself carefully.”

Although hearing what works from what other members is helpful, you’ll need to work with your doctor to come up with a plan that’s right for you.

Should You Use Benzoyl Peroxide for HS?

Many people include benzoyl peroxide in their HS skin care routine — but that’s not to say it helps everyone. “The benzoyl body wash is terrible,” said one member. “It gave me abscesses the size of a Ping-Pong ball.”

Another wrote, “The benzoyl peroxide wash also does not seem to give me any relief.”

Benzoyl peroxide isn’t recommended for people who take oral isotretinoin or use topical hydroquinone, due to the potential increased skin irritation and dryness. It’s generally considered safe to use during pregnancy and breastfeeding because your body only absorbs a little of it when you apply it to skin. However, there’s not a lot of research on safety for these populations. Letting your health care provider know about your other health conditions and medications can help them determine what’s safe for you.

If your dermatologist recommends benzoyl peroxide for hidradenitis suppurativa, try it and observe how your skin reacts. Changing one thing in your routine at a time can help you get a better idea of how it affects you. When you make multiple changes, it’s not always as easy to tell what’s responsible for a good or bad response.

If you’re nervous about irritation from benzoyl peroxide, you can start with a lower percentage or do a patch test on a small area of skin first before applying it to larger areas. According to the American Academy of Dermatology, you can test a new skin care product by applying a small amount to a spot of skin twice a day for seven to 10 days. If your skin doesn’t become discolored, itchy, or swollen, the product is likely safe to use.

Talk With Others Who Understand

On myHSteam, the social network for people living with hidradenitis suppurativa and their loved ones, more than 42,000 members come together to ask questions, give advice, and share their stories with others who know what it’s like.

Do you use benzoyl peroxide cleansers to treat HS lesions or nodules? From your experience, does benzoyl peroxide help or has it caused unpleasant side effects? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.