• Floor M van Diek, Nathalie Pruijn, Karin M Spijkers, Bert Mulder, Nienke M Kosse, and Oscar Dorrestijn.
• Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands. Electronic address: f.vandiek@gmail.com.
• J Shoulder Elbow Surg. 2020 Apr 1; 29 (4): 768-774.

Hypothesis And BackgroundWe hypothesized that benzoyl peroxide (BPO) would reduce the presence of Cutibacterium acnes on the skin of the shoulder by 50% compared with placebo. Infections after shoulder surgery are most commonly caused by C acnes. Current prophylactic methods do not effectively reduce the bacterial load of this bacterium. However, it seems that BPO may reduce C acnes on the skin of the shoulder. Therefore, this study aimed to investigate the effect of BPO on the presence of C acnes on the shoulder skin.MethodsA double-blinded, randomized, placebo-controlled trial was performed including healthy participants aged between 40 and 80 years. Thirty participants with C acnes on the shoulder skin according to baseline skin swabs were randomized into the BPO or placebo group. After gel application 5 times, skin swabs were taken to determine the presence of C acnes.ResultsForty-two participants were screened for the presence of C acnes to include 30 participants with the bacterium. Participants with C acnes at baseline were 7.4 years younger than participants without C acnes (P = .015). One participant in the placebo group dropped out before application because of fear of adverse events. After application, C acnes remained present in 3 of 15 participants (20.0%) in the BPO group and in 10 of 14 participants (71.4%) in the placebo group, resulting in a 51.4% reduction in the presence of C acnes.ConclusionApplying BPO 5 times on the shoulder skin effectively reduces C acnes. Consequently, BPO may reduce the risk of postoperative infections.Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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