Topical clindamycin in the management of acne vulgaris

Abstract

A small cadre of antimicrobials are commonly used and regarded as effective and safe, as systemic and topical treatments of acne vulgaris. These include oral tetracycline, doxycycline, minocycline and topical clindamycin and erythromycin. Topical antimicrobials work via both antimicrobial and non-antimicrobial mechanisms: the former due to suppression of the growth of propionibacterial species (especially Propionibacterium acnes and P. granulosum). Clindamycin appears to be superior in efficacy compared with erythromycin and tetracycline. However, the emergence and spread of resistance among propionibacteria to both erythromycin and clindamycin calls into question their long-term viability as topical anti-acne therapies. Only through judicious use of combination topical therapies (e.g., topical retinoid, benzoyl peroxide or azelaic acid plus clindamycin or erythromycin) and the practice of effective infection control (i.e., handwashing between seeing patients in the clinic) can both clindamycin's and erythromycin's widespread utility be preserved in this disorder.

Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne

“…Fourth, CL should likely rarely be used alone given its relatively inferior performance and the issue of antibiotic resistance. 8 Lastly, formulation has effects on product performance, as all studies using BPO 1 SA used the same solubilized BPO formulation and outperformed other products at the early end points.…”

Adult female acne: a new paradigm

“…Topical antibiotics have a direct anti‐inflammatory action and can also reduce the perifollicular lymphocytes involved in comedogenesis 18,31,32 . The substantial increase in resistant strains of P. acnes and other bacteria to clindamycin and erythromycin 33 means that these agents are not recommended as monotherapy for adult female acne, in patients who have received many previous topical antibiotic treatments 34 . The use of topical antibiotics in combination therapy should only be continued until no further clinical improvement is observed 34 …”

Taurine bromamine (TauBr) - its role in immunity and new perspectives for clinical use

“…One of the pathogenic factors of acne is P. acnes [22,23]. Topical antibacterial agents are an essential element of the armamentarium for the treatment of acne vulgaris [24,25]. As P. acnes , a potential pathogenic agent of acne, is extremely sensitive to TauBr, we hypothesized that TauBr may be a good candidate for the topical therapy for acne vulgaris, without the risk of inducing bacterial resistance [26,27].…”