Your Pharm Aid

May 15, 2024

Benzoyl Peroxide Benzene Concerns

On March 14, 2024, independent laboratory Valisure published a report in Environmental Health Perspectives (EHP) detailing its findings of very high benzene levels in a number of prescription and over the counter (OTC) benzoyl peroxide (BP) products.  Valisure has also petitioned the Food and Drug Administration (FDA) to recall BP-containing acne products.

The Valisure analysis found that benzoyl peroxide breaks down into benzene, especially under higher temperatures.  A known carcinogen, benzene exposure has been linked to leukemia and other blood cancers.  The FDA currently limits acceptable benzene concentrations to a maximum of 2 parts per million (ppm).  

The Valisure analysis examined 175 acne products (99 with BP and 76 with non-BP acne-fighting ingredients, like salicylic acid) from well-known brands like Equate, Neutrogena, CVS, Walgreens, Clean & Clear and Proactiv.  All of the non-BP products were either free of benzene or contained < 2 ppm.  Conversely, of the 99 BP products, 94 tested positive for benzene without being subjected to high temperatures.  Sixty-six products were subsequently exposed to the accepted pharmaceutical stability testing temperature of 122 degrees F (50 degrees C).  During the 18-day high-temperature testing period, 2 products yielded benzene concentrations higher than 1500 ppm, 17 products had concentrations in excess of 100 ppm, and 42 products had concentrations more than 10 ppm.  

Valisure concluded that potentially unsafe benzene levels may form in BP products, and may leak from packaging vessels into the surrounding air. 

Valisure’s testing methods are currently a subject of debate by FDA and the United States Pharmacopoeia, and as a result, benzoyl peroxide products have not yet been recalled.  Nevertheless, the findings above naturally present a cause for concern until the validity of the results are confirmed.  In the meantime, it is prudent to recommend that patients:

  • Discard expired benzoyl peroxide products, and those that may have been stored at higher temperatures.
  • Replace benzoyl peroxide products frequently (every 1-2 months).
  • Consider storing benzoyl peroxide products in the refrigerator in an effort to slow down benzene formation.
  • Consider a topical retinoid like adapalene 0.1% (available OTC) or tretinoin 0.025% (prescription only).
  • Consider topical salicylic acid (available OTC) or azelaic acid (Rx) for those who wish to avoid retinoids.


Expedited Partner Therapy Resources Available to Providers

The Wisconsin Department of Health Services (DHS) website contains a page with helpful resources available for medical providers as they assist in the treatment of sexually transmitted diseases (STD) of their patients and their sexual partners.  If the sexual partner of a patient is unable to seek testing and treatment of their own, a medical provider can treat the person via the expedited partner therapy (EPT) management design.  In addition, pharmacy providers are also able to dispense prescription medications to such individuals under this treatment management strategy.   
These practices are supported by Wisconsin legal statute per 2009 Wis. Act 280, which allows clinicians to treat their diagnosed patients and their partners for: 

  • Trichomoniasis 
  • Gonorrhea 
  • Chlamydia trachomatis  
  • In EPT, only the patient needs to be diagnosed; a medical evaluation is not required of the sexual partner. 

When treatment is given, health care providers must furnish information sheets to the patient receiving the EPT prescription.  These sheets contain information about the STD as well as the medication being used to treat it.  The DHS website provides links to these information sheets for all three of the STDs listed above, available in English, Spanish, and Hmong. 
In addition, more detailed information is available for health care providers further explaining the EPT model of care.  Links to these specific resources are provided to you below: 

For further information regarding the treatment of STDs, with specific information pertinent to Wisconsin patients and providers, click here to be directed to the DHS STD homepage.  

Drug Therapy Choices for Type 2 DM in Primary Care: ACP vs ADA Updated Recommendations

Guidelines are meant to help shape our clinical decision-making, and in recent years there has been an evolution in the direction of cardio-renal protection when selecting first-line drug therapy choices for persons with Type 2 diabetes (PWD).  The ADA/EASD and AACE guidelines are in sync with recommendations to choose medications from the glucagon-like-peptide-1 agonist (GLP1-RA) and sodium glucose cotransporter-2 inhibitor (SGLT2-I) class as first line therapy in persons with compelling indications (established ASCVD, high risk for ASCVD, Heart Failure, and CKD/DKD).   
Within the primary care realm, the American Diabetes Association (ADA) and the American College of Physicians (ACP) published specific documents for primary care clinicians in April 2024.  
The ACP document is available via Free Access, includes CME Point-of-Care, and a Visual Clinical Guideline that provides a treatment comparison by Effect Size (Risk ratio vs Absolute risk difference per 1000 treated individuals).1  In addition, the same issue of Annals included a Systematic Review and Meta analysis for drug effectiveness2 and cost-effectiveness3.  
ADA condensed the 321 page Standards of Care into a 42 page version in a user-friendly format that includes helpful graphics and bullet points applicable to primary care practice.4   
Although these publications overall are similar, the differences are presented in the chart below to help consider your individual approach to clinical therapeutic decision making in PWD:

Clinical Pharmacy Practitioner in Primary Care

Mike Grunske, PharmD, BCPS


Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).

Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.

Pharmacist at Advocate Aurora Health

Vanessa Grunske, PharmD, BCACP


Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.  

She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.

Professor at Concordia University Wisconsin School of Pharmacy

Beth Buckley, PharmD, CDCES


Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.

When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude. 

Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.

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