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

After 4 weeks of treatment, there was a marked decrease in inflammatory lesions on the forehead, nose, cheeks, and chin. Open and closed comedones were still present on the forehead, cheeks, and chin (Figure 4B). After 6 more weeks of clindamycin 1% BP 5% and adapalene gel 0.1% combination therapy, there was a decrease in new lesions on the forehead, nose, cheeks, and chin (Figure 4C).

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Patient 5 is a 23-year-old female with acne vulgaris who presented for follow-up. She had been using BP 6% gel (Triaz[R]) twice daily, adapalene gel 0.1% once daily at night, and a non-comedogenic moisturizer as needed for dryness, and a non-irritating, non-comedogenic cleanser. Upon examination, her forehead and cheeks were essentially clear, with one new inflammatory nodule on the right anterior chin, and resolving inflammatory lesions on both mandibles (Figure 5A). She was prescribed clindamycin 1% BP 5% gel to be applied once daily in the morning on her entire face. She was instructed to stop using the BP 6% gel, but to continue using the adapalene gel 0.1% once daily at night. After 6 weeks of clindamycin 1% BP 5% and adapalene gel 0.1% combination therapy, there was a decrease in new inflammatory lesions on the forehead, nose, cheeks, and chin with an especially marked improvement on the chin and anterior third of the mandibles (Figure 5B).

Patient 6 is a 17-year-old male with a 1- to 2-year history of acne vulgaris (Figure 6A). He was using tretinoin gel (Retin-A Micro[R]) every night for the previous 3 months. Prior to that, he had been using erythromycin 3% BP 5% without any effect. Upon examination, there were secondary excoriated inflammatory papules with open and closed comedones on the forehead, nose, cheeks, and chin. In addition, there was classic ice pick-like scarring on the medial mid-third of the cheeks. He was prescribed 100 mg of oral doxycycline hyclate to be taken once daily, and adapalene gel 0.1% to be applied once daily at night to his entire face. He was also instructed to use a non-irritating, non-comedogenic cleanser twice daily.

After 4 weeks of treatment, there was marked improvement with a substantial decrease in the number of inflammatory papules (70%-80%). There was still some small scarring on the cheeks as well as postinflammatory erythema of the cheeks. At this time, clindamycin 1% BP 5% gel, to be used once daily in the morning, was added to the treatment regimen. After 6 weeks of this treatment triad, there was a marked decrease in all new lesions with only minimal postinflammatory erythema of the cheeks (Figure 6B).

Discussion

These clinical reports demonstrate the tolerability and efficacy of clindamycin 1% BP 5% topical gel both as monotherapy and in combination with other acne vulgaris treatments. The combination of clindamycin 1% BP 5% gel provides the patient with a well-tolerated and efficacious therapeutic option. Clindamycin 1% has a mild comedolytic effect that reduces P. acnes and interleukin-1 production. (10) Topical antibiotics also provide some anti-inflammatory activity by suppressing leukocyte chemotaxis. (19) Both clindamycin 1% and BP 5% provide antibacterial activity, and the keratolytic action of BP may improve the penetration of clindamycin 1% into the skin. In patients 1 and 2 where clindamycin 1% BP 5% gel was used alone, there was a marked reduction in the number of inflammatory papules, pustules, and nodules in both patients, and a decrease in all new inflammatory lesions, with no evidence of nodules or cysts in patient 1. In patient 3, the daily regimen of clindamycin 1% BP 5% gel resulted in a dramatic improvement of inflammatory papules and pustules on the patient's face after 4 weeks of treatment.