Safety and efficacy
Proactiv is aimed at customers with mild to moderate acne.[21] According to a 2011 review, there have been few studies examining its efficacy.[2] A 2007 study saw inflammatory lesions reduced by 39% in subjects using a combination of butenafine and benzoyl peroxide, compared with 34% in those using Proactiv containing only benzoyl peroxide.[2][22] A physician suggested in Salon that its three-step system might make it easier for teenagers to comply, but that the key to its success lay with its celebrity endorsements.[23]
In 2011, Consumer Reports compared Proactiv (2.5% benzoyl peroxide) with two less expensive products, AcneFree (2.5% benzoyl peroxide) and OXY Maximum (10% benzoyl peroxide). At the time a two-month supply of Proactiv cost around $40 in the US, AcneFree $20 and OXY Maximum $5.[4] Eighty-three subjects, aged 14 to 40, used one of the products twice a day for eight weeks. The magazine reported that, no matter which product was used, after two weeks, around 75% of subjects saw a 35% reduction in blemishes on average. After eight weeks, around 50–66% saw a 40% reduction on average.[24]
Benzoyl peroxide can have a drying effect on the skin, can cause erythema (redness) and fine scaling, though these effects are usually mild, and can increase sensitivity to sunlight. One in 500 may experience allergic contact dermatitis. It is categorized as a pregnancy category C agent, "suggesting that its use in pregnancy may not be prudent," according to a literature review in the Journal of Clinical and Aesthetic Dermatology. If benzoyl peroxide comes into contact with clothing it is likely to bleach it.[26]
The US Food and Drug Administration (FDA) warned in 2014 that over-the-counter acne products containing benzoyl peroxide and/or salicylic acid, including Proactiv, can cause severe irritation, as well as rare but life-threatening allergic reactions. Consumers were advised to stop using the products if they experience hives or itching, and to seek emergency medical attention if they feel faint, or experience throat tightness, breathing problems, or swelling of the eyes, face, lips or tongue. The FDA noted that it remains unclear whether the reactions are caused by the active ingredients, inactive ingredients or a combination.[27]
