Topical benzoyl peroxide application on the shoulder reduces Propionibacterium acnes: a randomized study

• Published in: Journal of shoulder and elbow surgery Vol. 27; no. 6; pp. 957 - 961
• Main Authors: Scheer, Vendela M., Bergman Jungeström, Malin, Lerm, Maria, Serrander, Lena, Kalén, Anders
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2018
• Subjects: Administration, Cutaneous; Adult; Aged; Anti-Infective Agents, Local - administration & dosage; benzoyl peroxide; Benzoyl Peroxide - administration & dosage; chlorhexidine; Chlorhexidine - administration & dosage; Colony Count, Microbial; Female; Gels; Humans; infection; Male; Middle Aged; Preoperative Care; preoperative shower; Propionibacterium acnes; Propionibacterium acnes - drug effects; shoulder; Shoulder - microbiology; Shoulder - surgery; Shoulder Joint - surgery; Single-Blind Method; Skin - microbiology; Young Adult; Treatment Study; infection; benzoyl peroxide; preoperative shower; chlorhexidine; Level I; Randomized Controlled Trial; Propionibacterium acnes; shoulder
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2018.02.038

Propionibacterium acnes is a common cause of infection following shoulder surgery. Studies have shown that standard surgical preparation does not eradicate P acnes. The purpose of this study was to examine whether topical application of benzoyl peroxide (BPO) gel could decrease the presence of P acnes compared with today's standard treatment with chlorhexidine soap (CHS). We also investigated and compared the recolonization of the skin after surgical preparation and draping between the BPO- and CHS-treated groups. In this single-blinded nonsurgical study, 40 volunteers—24 men and 16 women—were randomized to preoperative topical treatment at home with either 5% BPO or 4% CHS on the left shoulder at the area of a deltopectoral approach. Four skin swabs from the area were taken in a standardized manner at different times: before and after topical treatment, after surgical skin preparation and sterile draping, and 120 minutes after draping. Topical treatment with BPO significantly reduced the presence of P acnes measured as the number of colony-forming units on the skin after surgical preparation. P acnes was found in 1 of 20 subjects in the BPO group and 7 of 20 in the CHS group (P = .044). The results remained after 2 hours (P = .048). Topical preparation with BPO before shoulder surgery may be effective in reducing P acnes on the skin and preventing recolonization.