Clinical assessment involving human volunteers must be conducted safety and anti-acne the effectiveness of the formulation.[40] to validate

The gap

Evidence profile

Sourced from the recommendations of the source papers, classified as general, drawn from work published between 2024 and 2026, spanning 4 journals. Those papers have been cited 60 times in total.

Supporting evidence — 4 representative gaps

• The Comprehensive Systematic Review of Use of Benzoyl Peroxide as Monotherapy or Combination Therapy for Acne (2026) · The International Journal of Medical Science and Health Research · doi

  • For mild acne: Start with BPO 2.5%–3.75% monotherapy once daily. • For moderate-to-severe acne: Prescribe a fixed-dose combination: either adapalene 0.1%/BPO 2.5% or clindamycin 1.2%/BPO 3.75% as first-line. • For severe acne or when rapid response is needed: Consider the triple combination CAB gel (if available), which offers the highest efficacy. • For scar prevention: Adapalene/BPO (0.3%/2.5%) is strongly recommended based on 48- week scar reduction data. • Future research: Independent, head-to-head trials comparing CAB versus oral antibiotics + topical BPO, and studies in diverse ethnic populations, are needed. REFERENCES 1. Lamel SA, Sivamani R, Rahvar M, Maibach H (2015) Evaluating clinical trial design: systematic review of randomized vehicle-controlled trials for determining efficacy of benzoyl peroxide topical therapy for acne. Archives of Dermatological Research. https://doi.org/10.1007/s00403-015-1568-9 2. Kawashima M, Sato S, Furukawa F, et al (2017) Twelve‐week, multicenter, placebo‐ controlled, randomized, double‐blind, parallel‐group, comparative phase II/III study of benzoyl peroxide gel in patients with acne vulgaris: A secondary publication. Journal of dermatology (Print). https://doi.org/10.1111/1346-8138.13798 The International Journal of Medical Science and Health Research Downloaded from theInternationalmedicaljournal.org. For personal use only. No other uses without permission. Copyright © International Medical Journal Corp. Ltd. All rights reserved 475  Research Article Volume 48, Issue No. 01. 2026 E-ISSN : 3048-1368 P-ISSN : 3048-1376 3. Kawashima M, Hashimoto H, Saenz AAA, et al (2014) Is benzoyl peroxide 3% topical gel effective and safe in the treatment of acne vulgaris in Japanese patients? A multicenter, randomized, double‐blind, vehicle‐controlled, parallel‐group study.

  generalrecommendations
  Keywords: acne topical randomized controlled benzoyl peroxide journal severe combination adapalene needed efficacy scar week head
• FORMULATION AND EVALUATION OF ACNE FACE WASH CONTAINING TULSI, NEEM, AND ACTIVATED CHARCOAL (2026) · Zenodo (CERN European Organization for Nuclear Research) · doi

  Clinical assessment involving human volunteers must be conducted safety and anti-acne the effectiveness of the formulation.[40] to validate Long-term stability assessments are necessary ascertain shelf life and suitable storage conditions.[50] to It is essential to optimize the concentration of herbal extracts to attain the highest therapeutic efficacy.[51] The addition of other herbal components, such as aloe vera and turmeric, may improve anti-acne and soothing properties.[52] In-vitro antimicrobial tests should be carried out against acne-related microorganisms, including Cutibacterium acnes.[53] Studies on dermatological safety and skin irritation must be performed to confirm compatibility with all skin types.[54] www.ejpmr.com │ Vol 13, Issue 5, 2026. │ ISO 9001:2015 Certified Journal │ 70 Mansi et al. European Journal of Pharmaceutical and Medical Research Scale-up practicality of large-scale manufacturing[55] investigations are needed to assess the of

  generalrecommendations
  Keywords: acne must safety anti herbal skin journal scale clinical assessment involving human volunteers conducted effectiveness
• Topical Retinoids Versus Benzoyl Peroxide in Acne Maintenance Therapy: Comparative Role, Evidence, And Practical Use (2026) · International Journal of Medical Science and Clinical Research Studies · doi

  lesion development. Benzoyl peroxide remains new important for inflammatory relapse prevention, antimicrobial activity, and antibiotic stewardship. Direct head-to-head maintenance evidence is limited, but available studies and retinoid-based guideline-based maintenance, particularly when long-term relapse prevention is the goal. Retinoid–benzoyl peroxide combinations appear to provide the strongest maintenance strategy for relapse- prone patients, especially after moderate-to-severe acne, oral should antibiotics, be individualized according tolerability, pregnancy status, relapse pattern, and adherence. isotretinoin. Treatment lesion favor type, or to REFERENCES I. II. III. IV. V. VI. VII. Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10. doi:10.7573/dic.2021-8-6 Bettoli V, Borghi A, Zauli S, Toni G, Ricci M, Giari S, Virgili A. Maintenance therapy for acne vulgaris: efficacy of a 12-month treatment with adapalene- benzoyl peroxide after oral isotretinoin and a review of the literature. Dermatology. 2013;227:97-102. doi:10.1159/000350820 Leyden J. Recent advances in the use of adapalene 0.1%/benzoyl peroxide 2.5% to treat patients with moderate to severe acne. J Dermatolog Treat. 2016;27:S13-S14. doi:10.3109/09546634.2016.1145338 Emmerich V, Purvis C, Feldman S. An overview of adapalene and benzoyl peroxide once-daily topical gel as a therapeutic option for acne. Expert Opin 2021;22:1661-1667. Pharmacother. doi:10.1080/14656566.2021.1939678 Ullah A, Muhammad A, Mehmood F, Farooq H, Ahmad B, Haq AB, et al. Comparing the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalene for treatment of acne vulgaris in skin of color population: a South Asian perspective. Cureus. 2024;16:e55555. doi:10.7759/cureus.55555 Fahim B, Shaikh MA, Ejaz T, Batool P. Evaluating topical treatments for mild to moderate acne: a cross-sectional study. Ukr J Med Biol Sport. 2024. doi:10.63341/ujmbs/4.2024.016 Aschoff R, Möller S, Haase R, Kuske M. Tolerability and efficacy of clindamycin/tretinoin versus adapalene/benzoyl peroxide in the treatment of acne vulgaris. J Drugs Dermatol. 2021;20:295- 301. doi:10.36849/JDD.2021.5641 VIII. Mavranezouli I, Daly C, Welton N, Deshpande S, Berg L, Bromham N, et al. A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Br J Dermatol. 2022;187:639-649. doi:10.1111/bjd.21739 1464 Volume 06 Issue 07 July 2026 Corresponding Author: Fatima Monserrath Contreras Raya Topical Retinoids Versus Benzoyl Peroxide in Acne Maintenance Therapy: Comparative Role, Evidence, And Practical

  generalrecommendations
  Keywords: acne benzoyl peroxide topical maintenance vulgaris adapalene relapse treatment moderate oral efficacy versus lesion prevention
• The Role of the Skin Microbiome in Acne: Challenges and Future Therapeutic Opportunities (2024) · International Journal of Molecular Sciences · cited 60× · doi

  Topical antibiotics such as clindamycin and erythromycin are frequently used to com- bat C. acnes and other bacteria involved in acne. These antibiotics inhibit bacterial protein synthesis, reducing the bacteria that contribute to acne. However, their broad-spectrum activity can disrupt the skin’s microbiome by affecting both harmful and beneficial bacteria. The emergence of C. acnes resistance has been linked to the introduction of topical antibi- otic treatments in the 1970s [51]. Clinically significant resistance of C. acnes to antibiotics was first documented in 1983 in the U.S. among patients who did not respond well to oral antibiotic therapy [52]. Over time, various antibiotics, including topical clindamycin, erythromycin, oral macrolides, tetracyclines, and cephalexin, have been extensively used in acne management [53]. Reports of antimicrobial resistance in other bacteria from acne patients, such as S. aureus and S. epidermidis, have also been noted. A study involving Korean acne patients reported high resistance rates of S. epidermidis to tetracycline (31%), doxycycline (27%), clindamycin (33%), and erythromycin (58%) [54]. Additionally, a related Indonesian study involving 93 isolates showed 42.9% susceptibility to erythromycin and 71.4% to tetracycline [55]. For instance, a study in Jordan found that 35% of S. aureus and 25% of S. epidermidis isolates were antibiotic-resistant [56]. These findings highlight the growing concern of antibiotic resistance in acne treatment, emphasizing the need for alternative therapeutic approaches and more judicious use of antibiotics to preserve their efficacy. 3.1. Clinical Implications of Antibiotic Resistance in Acne A French study involving 1472 hospitalized patients showed that all Cutibacterium strains were susceptible to amoxicillin, ceftriaxone, vancomycin, and moxifloxacin [57]. However, 15% of C. acnes strains exhibited resistance to erythromycin, 4.1% to clindamycin, and 2.2% to tetracycline. This resistance highlights the adaptive nature of C. acnes, espe- cially when it forms biofilm communities on the skin and within sebaceous glands [58]. In biofilms, C. acnes is shielded from antibiotics, as the biofilm matrix reduces the penetration of effective drug concentrations [59]. Within these biofilms, the bacteria communicate through quorum sensing and exhibit reduced metabolic activity, which further protects them from antibiotic treatments [60]. When C. acnes shifts from the biofilm to a plank- tonic state, however, it can trigger new protein expression, enhancing its ability to tolerate antibiotics. This dual behavior of C. acnes—biofilm formation and planktonic adaptation— demonstrates the complexity of its role in both antibiotic resistance and maintaining balance in the skin microbiome. Studies have shown varying effects of C. acnes on biofilm devel- Int. J. Mol. Sci. 2024, 25, 11422 8 of 20 opment in other bacteria. For example, C. acnes supernatants reduced S. aureus biofilm mass

  generalrecommendations
  Keywords: acnes resistance antibiotics acne bacteria antibiotic biofilm erythromycin clindamycin patients topical skin aureus epidermidis involving

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