Clindamycin/benzoyl peroxide gel: a review of its use in the management of acne

Abstract

Clindamycin/benzoyl peroxide gel has demonstrated clinical efficacy in the treatment of acne vulgaris through both antibacterial and anti-inflammatory means. Benzoyl peroxide may exert its antibacterial activity by the interaction of oxidized intermediates with elements of bacterial cells. Clindamycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunits causing inhibition of peptide-bond formation. Benzoyl peroxide decreases inflammatory damage by inhibiting the release of reactive oxygen species from polymorphonuclear leukocytes (PMNs) through the killing of PMNs. Clindamycin suppresses the complement-derived chemotaxis of polymorphonuclear leukocytes in vitro, thereby reducing the potential for inflammation. Several well designed clinical trials have demonstrated that twice-daily application of clindamycin 1%/benzoyl peroxide 5% gel for 10 to 16 weeks was more effective in reducing the number of inflammatory lesions than benzoyl peroxide 5%, clindamycin 1% or vehicle in patients with mild to moderately severe acne. Two studies also showed clindamycin/benzoyl peroxide to be more effective than benzoyl peroxide, clindamycin or vehicle in reducing total lesions, and one study showed clindamycin/benzoyl peroxide to be significantly more efficacious than clindamycin or vehicle in reducing the number of noninflammatory lesions. Moreover, in two trials, physician-rated mean global improvement scores, as well as patient-rated scores in one of those trials, were significantly greater in the clindamycin/benzoyl peroxide group than in the benzoyl peroxide, clindamycin or vehicle groups. In another study, clindamycin/benzoyl peroxide was as efficacious as benzoyl peroxide/erythromycin in the reduction of inflammatory and noninflammatory lesions and in raising mean global improvement scores, but was significantly more effective than benzoyl peroxide in the reduction of inflammatory lesions and in increasing both physician- and patient-assessed global improvement scores. Clindamycin/benzoyl peroxide gel applied twice daily was well tolerated in clinical trials in patients with acne, and has a tolerability profile similar to that of benzoyl peroxide alone. The most common adverse events were dry skin, peeling, erythema and rash; however, adverse event-caused treatment discontinuation rates for patients using clindamycin/benzoyl peroxide were low, ranging from 0 to 0.8%.

Conclusions: Clindamycin/benzoyl peroxide gel has demonstrated efficacy and good overall tolerability in several well designed clinical studies in the topical treatment of patients with mild to moderately severe acne vulgaris. Clindamycin/benzoyl peroxide was more effective than benzoyl peroxide, clindamycin or vehicle, and similar in efficacy to benzoyl peroxide/erythromycin in the reduction of inflammatory lesions and in raising physician- and patient-assessed mean global improvement scores. It may be useful in treating patients with acne caused by resistant strains of Propionibacterium acnes. Clindamycin/benzoyl peroxide gel is an effective topical agent in the treatment of patients with mild to moderately severe acne. It is a suitable alternative for patients who are currently using topical antibacterials either alone or in conjunction with other topical anti-acne agents or systemic antibacterials.