There are several types of treatment that you can recommend to your patient, which affect different pathophysiological factors implicated in the development of acne. These include topical and oral retinoids, topical and oral antibiotics, benzoyl peroxide and azelaic acid. Fixed dose combinations of these agents include adapalene plus benzoyl peroxide, clindamycin plus benzoyl peroxide, erythromycin plus tretinoin, erythromycin plus isotretinoin, anderythromycin plus zinc. However, when considering the best treatment for individuals and the severity oftheir acne, doctors need to find the right combination of treatment efficacy, onset of action and risk of side effects.
Compared with erythromycin plus zinc acetate combination therapy, the combination of benzoylperoxide and clindamycin results in
efficacy and a fast onset of action 3
Significantly more patients had a ≥30% reduction in inflammatory (Week 2) and non- inflammatory lesion counts (Weeks 1 and 2) with benzoyl peroxide plus clindamycin 5% versus erythromycin 4% plus zinc acetate 1.2% (primary endpoint)
Adapted from Langner A, et al. J Eur Acad Dermatol Venereol 2007;21:311–319.
- After 2 weeks of treatment, treatment with benzoyl peroxide plus clindamycin 5% resulted in significant improvement in total lesion counts versus erythromycin plus zinc acetate (p=0.017; secondary endpoint)
…a similar tolerability profile 3
- The incidence of erythema, dryness, peeling, pruritus, and burning/stinging was similar between the benzoyl peroxide plus clindamycin 5% (0–4.1%) and erythromycin plus zinc acetate (0–5.3%) groups
- There were few discontinuations due to adverse events in the benzoyl peroxide plus clindamycin 5% and erythromycin plus zinc acetate treatment groups (1.3% for both)
Compared with adapalene 0.1% therapy, the combination of benzoyl peroxide and clindamycin 5% results in
…greater efficacy and a faster onset of action 4
- Treatment with benzoyl peroxide and clindamycin 5% resulted in a significant reduction in inflammatory lesions compared with adapalene 0.1% as early as Week 2 (P≤0.001)
- Treatment with benzoyl peroxide and clindamycin 5% resulted in a significantly greater improvement in acne grade from Week 1 to 12 compared with adapalene 0.1% (P<0.05)
*** P≤0.001 versus adapalene; C/BPO, Clindamycin plus benzoyl peroxide (n=65); ADA, adapalene (n=65)
Adapted from Langner A, et al. Br J Dermatol 2008;158:122–129.
…a comparable tolerability profile 4
- Overall tolerance (good or excellent, as assessed by the investigator) at week 12 was higher with benzoyl peroxide and clindamycin 5% versus adapalene 0.1% (77.0 vs 52.3%)
- The incidence of adverse events, such as erythema, dryness and burning, was similar between the benzoyl peroxide plus clindamycin 5% (32.3%) and adapalene 0.1% (30.8%) groups
- However, there were more treatment-related adverse events in the adapalene 0.1% treated patients (10.8 versus 1.5%)
Compared with the single components, the combination of benzoyl peroxide and clindamycin 5% results in…
…greater efficacy 6
Significantly more benzoyl peroxide plus clindamycin 5%-treated patients achieved good or excellent global responses after 11 weeks versus clindamycin 1% and benzoyl peroxide 5% alone (*p≤0.001 for all comparisons)
After 11 weeks of treatment, in terms of global acne improvement, a significantly higher percentage of patients treated with benzoyl peroxide plus clindamycin 5% (66%) achieved a ‘good’ or ‘excellent’ global acne improvement, compared with clindamycin 1% (36%) and benzoyl peroxide 5% (41%) monotherapies (p<0.05 for both comparisons)
…a faster onset of action 6
- At Week 2, the combination of benzoyl peroxide plus clindamycin 5% achieved a significantly greater mean percentage reduction in inflammatory lesion count versus clindamycin 1% and benzoyl peroxide 5% monotherapies (p<0.02)
*Statistically significant difference versus BPO; †Statistically significant difference versus CDP.
All treatments were significantly different at all timepoints versus vehicle. Adapted from
Lookingbill DP, et al. J Am Acad Dermatol 1997;37:590–95.
…similar tolerability 6
- Benzoyl peroxide plus clindamycin 5% and individual constituent components showed to be well tolerated with few adverse events
- Peeling was the most common adverse event (observed in up to 22% ofclindamycin 1% and benzoyl peroxide 5%-treated patients), followed by drying and erythema
- Fagundes D, et al. New therapy update: A unique combination formulation in the treatment of inflammatory acne. Cutis 2003;72(1 Suppl):16–9
- Nast A, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 2012;26 Suppl 1:1–29.Zouboulis C, et al. Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis 2009;84:223–229.
- Langner A, et al. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide (Duac®) and erythromycin + zinc acetate (Zineryt®) in the treatment of mildto moderate facial acne vulgaris J Eur Acad Dermatol Venereol 2007;21:311–319.
- Langner A, et al. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide and adapalene in the treatment of mild to moderate facial acne vulgaris. Br J Dermatol 2008;158:122–129.
- Guerra-Tapia A, et al. Effects of benzoyl peroxide 5% clindamycin combination gelversus adapalene 0.1% on quality of life in patients with mild to moderate acne vulgaris: A randomized single-blind study. J Drugs Dermatol 2012;11:714–722.
- Lookingbill DP, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: Combined results of two double-blind investigations J Am Acad Dermatol 1997;37:590– 95.