Topical benzoyl peroxide for 48 h preoperatively has been shown to reduce the bacterial load of P. acnes on the skin.
These authors investigated whether skin preparation with a single application of benzoyl peroxide combined with 2% chlorhexidine/ alcohol immediately prior to surgery was superior to 2% chlorhexidine/alcohol alone at inhibiting P. acnes.
They conducted a single-blinded interventional study in which they compared the effectiveness of (1) the application of benzoyl peroxide followed by chlorhexidine/alcohol to the shoulder to (2) two applications of 2% chlorhexidine/alcohol.
Superficial skin swabs for semi-quantitative culture were taken pre- and postskin preparation.
A total of 22 male participants were randomized; all participants were colonized with P. acnes on baseline swabs.
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A total of 22 male participants were randomized; all participants were colonized with P. acnes on baseline swabs.
They found found complete inhibition of P. acnes at 14 days at 80% of sites prepared with benzoyl peroxide + chlorhexidine/alcohol compared with 86% inhibition at shoulder sites prepared with chlorhexidine alone.
They concluded that their was no additional benefit in the addition of benzoyl peroxide to the surgical preparation.
They concluded that their was no additional benefit in the addition of benzoyl peroxide to the surgical preparation.
Comment: BPO appears to be effective in reducing propionibacterium (cutibacterium) load on the skin of male patients when applied multiple times before the day of surgery. This study suggests that it is not effective when applied a single time as a part of the immediate preoperative skin preparation. Perhaps multiple applications are required for BPO to adequately penetrate these glands and significantly reduce the bacteria within the skin.
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