Comparative efficacy and skin barrier effects of topical dapsone and benzoyl peroxide in acne vulgaris.

Background: Acne is commonly treated with topical agents such as benzoyl peroxide (BP), which is effective but limited by side effects. Topical dapsone may offer a better-tolerated alternative. Objective: To compare the efficacy and safety of topical 5% dapsone versus 2.5% BP in mild-to-moderate acne. Materials and methods: Fifty patients with mild-to-moderate acne were enrolled and randomized. Outcomes included reduction in acne lesion count (inflammatory, noninflammatory, and total), Global Acne Assessment Score (GAAS), patient satisfaction, transepidermal water loss, and side effects. Results: Forty-four patients completed 12 weeks of treatment (20 with 5% dapsone, 24 with 2.5% BP). Both treatments significantly reduced acne lesions and GAAS scores. Dapsone 5% was more effective in reduction of inflammatory lesions, whereas BP 2.5% was more effective for noninflammatory lesions. Dapsone 5% also achieved a faster reduction in total acne lesions and GAAS scores. Transepidermal water loss increased significantly with BP 2.5%, but not with dapsone 5%. Local side effects, particularly pruritus and erythema, were more frequent with BP. Limitations: Single-center design and short study duration. Conclusion: Topical 5% dapsone is an effective and well-tolerated option for mild-to-moderate acne, particularly for inflammatory lesions, and may serve as an alternative for patients intolerant to standard therapies.