Topical Retinoids Versus Benzoyl Peroxide in Acne Maintenance Therapy: Comparative Role, Evidence, And Practical Use

Abstract

Acne vulgaris is a chronic inflammatory disorder with a high tendency for relapse after initial improvement. Maintenance therapy is therefore essential to prevent recurrence, reduce new lesion formation, minimize scarring, and maintain long-term disease control. Topical retinoids and benzoyl peroxide are two major non-antibiotic agents used in acne treatment, but they have different roles in maintenance. Topical retinoids are generally considered the core maintenance therapy because they target microcomedone formation, normalize follicular keratinization, and prevent the development of both comedonal and inflammatory lesions. Benzoyl peroxide provides antimicrobial and anti-inflammatory activity without inducing bacterial resistance and is especially useful when inflammatory relapse remains a concern. However, benzoyl peroxide alone is less often positioned as the primary long-term maintenance agent compared with topical retinoids. Current evidence suggests that retinoid–benzoyl peroxide combinations may offer the strongest relapse prevention, particularly in patients with moderate-to-severe acne, recent isotretinoin therapy, or high risk of recurrence. This review compares topical retinoids and benzoyl peroxide for acne maintenance, emphasizing mechanism of action, efficacy, tolerability, relapse prevention, combination therapy, and practical selection.