Although benzoyl peroxide is a foundation of acne treatment, many patients are not following physician recommendations for its use, and its over-the-counter (OTC) availability may actually be a hindrance to adherence.

In a letter to the editor of the Journal of the American Academy of Dermatology, Andrea L. Zaenglein, MD , and Annie H. Huyler, of Penn State University, Hershey, reported the results of a telephone survey of 84 acne patients, aged 12-45 years. Fewer than a third (29%) recalled having received a recommendation for an OTC medication, and just 30% could recall that benzoyl peroxide (BP) was the recommended active ingredient ( J Am Acad Dermatol. 2017 Oct;77[4]:763-4 ).

Curious about whether acne patients actually followed their treatment plans when it came to OTC BP, they arranged to have patients surveyed by telephone. New patients aged 12-45 years with an acne diagnosis who had been recommended BP were eligible.

The series of 10 survey questions began with more open-ended questions and moved to more close-ended questions. Of the 64% of patients who did buy an OTC product, further questioning revealed that half (32%) had actually purchased a BP-containing product. A total of 15% of patients had instead bought a face wash containing salicylic acid, and 17% of the products purchased had no active ingredient.

By contrast, the telephone survey revealed that all but one patient (93%) had filled the prescription for acne medication.

Benzoyl peroxide, which used to be available either by prescription or over the counter, has been available exclusively over the counter since 2011.

“The results from this study confirm that patient adherence to dermatologist-recommended BP is low,” they wrote. “Furthermore, of those who remembered BP by name, many were unable to find the correct product and instead had purchased an item with the wrong ingredient or no active ingredient,” they added. The findings are in line with other studies showing that patients are less likely to be adherent to recommendations to use OTC medications than they are to fill prescriptions for and take prescription medications, Ms. Huyler and Dr. Zaenglein wrote.

“Better education, in-office dispensing of BP, or fixed-dose combination prescription products are possible solutions,” they said.

The authors noted that their findings were limited by the exclusion of non-English speaking patients and by the fact that they used a nonvalidated telephone survey.

Ms. Huyler is a medical student and Dr. Zaenglein is a professor of dermatology at Penn State; they reported no conflicts of interest. The study had no external sources of funding.