Public Release: 

Topical benzoyl peroxide efficacy on Propionibacterium acnes reduction in shoulder surgery

Study in Journal of Shoulder and Elbow Surgery evaluates the effect of using the active ingredient in Clearasil to reduce infection


Greenwich, CT, 30 June, 2015 - A new paper to be published in The Journal of Shoulder and Elbow Surgery evaluates the effect that topical benzoyl peroxide (BPO), with chlorhexidine skin preparation, has on the presence of Propionibacterium acnes cultured at the time of shoulder surgery. The authors hypothesized that adding topical BPO, the active ingredient in Clearasil, to the pre-operative skin preparation would reduce the number of positive P. acnes cultures identified during surgery.

P. acnes infection is a significant problem after shoulder surgery. Residual P. acnes is found on the skin up to 29% of the time immediately after surgical skin preparation and in 70% of dermal biopsy specimens. These residual bacteria may be a source for infection. Identifying more ideal skin preparation may help reduce the risk of infection.

Fifty patients undergoing first-time (arthroscopic) shoulder surgery were treated with topical 5% BPO cream 48 hours before surgery. After skin preparation, 13 samples per subject were obtained. These cultures were held for 14 days and 650 culture specimens were obtained. The skin was positive at the initiation of surgery in 6% of the cases and tissue samples were positive in 6%. The skin was positive in 10% at the end of surgery. None of these rates of positive culture were different from the 4% rate observed with a control swab.

Application of BPO is an effective way to reduce P. acnes on skin at the beginning and, importantly, at the end of a surgical procedure. This may result in a lower risk for postoperative infection.

"The setbacks and costs associated with infection after shoulder surgery are significant," said senior author Paul M. Sethi, Clinical Instructor of Orthopedic Surgery Yale University School of Medicine. "Our first study identified the patients' skin as the source of bacteria that may cause infection and highlighted the limitations of current skin surgical preparation. Our team used established dermatologic principles to improve the way we clean the skin. Dermatologists have used BPO to treat P. acnes on our face for 50 years. We chose to study this same medicine on the shoulder and the findings are very exciting. Data demonstrates that we can significantly reduce potentially dangerous bacteria after skin treatment with BPO. By reducing these bacteria, we hope to reduce the risk for shoulder infection following surgery."


Notes for editors

The article is "Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery" by James R. Sabetta, MD, Vishal P. Rana, BS, Katherine B. Vadasdi, MD, R. Timothy Greene, MD, James G. Cunningham, MD, Seth R. Miller, MD, Paul M. Sethi, MD ( The is published in Journal of Shoulder and Elbow Surgery, Volume 24, Issue 7 (July 2015), published by Elsevier; available online on ScienceDirect.

A copy of the paper is available to credentialed journalists upon request. Please contact Elsevier's Newsroom at or +31 20 4853564.

About Journal of Shoulder and Elbow Surgery

The official publication for eight leading specialty organizations, The Journal of Shoulder and Elbow Surgery (JSES) is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow.

Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. The JSES features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty and rehabilitation.

JSES is among the most highly cited journals in orthopedics. It is ranked 19th out of 67 titles in the Journal Citations Reports® published by Thomson Reuters. The most recent Impact Factor score for JSES is 2.365.

About Elsevier

Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions -- among them ScienceDirect, Scopus, Elsevier Research Intelligence, and ClinicalKey -- and publishes over 2,500 journals, including The Lancet and Cell, and more than 33,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group plc, a world-leading provider of information solutions for professional customers across industries.

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