Clinical experience results with clindamycin 1% benzoyl peroxide 5% gel as monotherapy and in combination

Journal of Drugs in Dermatology, March-April, 2005 by Joseph B. Bikowski

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After 2 weeks of treatment, the patient's assessment of improvement was 50%. There was a marked decrease in the number of inflammatory papules and pustules of the anterior aspects of the cheeks, right malar eminence, the medial third of the left cheek, anterior chin, and forehead, and there was no evidence of new papules, pustules, or nodules (Figure 1B). At this time, she complained of slight drying. She was instructed to use a non-comedogenic moisturizer twice daily, and to continue using clindamycin 1% BP 5% gel as instructed.

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After 6 weeks of treatment, there was even greater improvement (75%-80%). There was a decrease in all new inflammatory lesions on the forehead, cheeks, and chin, and no evidence of nodules. The majority of skin changes could be accounted for by postinflammatory erythema, and the patient was reassured that this would fade. There were one or two new inflammatory papules noted on the anterior third of the cheeks bilaterally, but nothing to warrant systemic treatment.

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Patient 2 is an 18-year-old male with a 2-month flare of moderately severe grades 1, 2, and 3 acne (Figure 2A). Upon examination, he had inflammatory papules and pustules, and open and closed comedones of the forehead. He had tried 4 days of a sample of adapalene gel 0.1% and 2 months of an over-the-counter generic time-released BP/sulfur formulation without any effect. He was prescribed clindamycin 1% BP 5% gel once daily at night. He was also instructed to use a non-irritating, non-comedogenic cleanser twice daily.

After 6 weeks of treatment, the patient assessed improvement at 70%. There was a marked reduction in the number of inflammatory papules and pustules on the forehead (Figure 2B). His cheeks and chin were free of inflammatory and non-inflammatory lesions; there was postinflammatory erythema on the forehead, but he was reassured that this would fade over time.

Patient 3 is an 18-year-old male with inflammatory papules and pustules of the cheeks, neck, upper shoulders, and back (Figure 3A). He had been using ketoconazole (Nizoral[R]) tablets and adapalene gel 0.1%, but with little response. He was prescribed clindamycin 1% BP 5% gel to apply once daily at night to his face, neck, shoulders, and back. He was instructed to stop the adapalene gel 0.1% and to try a sample of ciclopirox 1% shampoo (Loprox[R]) to use on his scalp, face, shoulders, and back.

After 4 weeks of treatment, there was a dramatic improvement of the lesions on his face (Figure 3B). There were still minute, 1 to 2 mm papules and pustules (Pityrosporum folliculitis) on the upper back, shoulders, and cheeks. It was recommended that the patient start on itraconazole (Sporanox[R]), but he did not want to start taking pills at that time. Ciclopirox 1% shampoo was added to his clindamycin 1% BP 5% treatment regimen with continued success.

Patient 4 is a 17-year-old male who presented for follow-up for acne vulgaris. Upon examination, he had inflammatory papules and inflammatory comedones on the forehead and cheeks, as well as multiple open and closed comedones on the forehead, cheeks, and chin (Figure 4A). He had been using adapalene gel 0.1% once daily at night and a non-irritating, non-comedogenic cleanser twice daily. He was started on clindamycin 1% BP 5% gel to use sparingly every morning on his entire face and was instructed to continue using the adapalene gel 0.1% and the non-irritating, non-comedogenic cleanser.