- Clindamycin is an antibiotic used to treat acne.
- Topical clindamycin is part of the treatment of mild, moderate, or severe acne.
- You may begin to see improvements two to six weeks after starting treatment.
- Combination therapy with other acne medications is recommended.
Acne vulgaris (or just acne) develops when skin pores, particularly in the face and upper body, get clogged by accumulated oils, dead skin cells, and inflammatory debris. It can cause long-lasting or permanent scarring.
Acne is partly caused by the effects of bacteria on the skin, making antibiotic therapy a staple in acne treatment.
What Is Clindamycin?
Clindamycin is an antibiotic that was developed in the 1960s by chemically modifying lincomycin, a natural antibiotic. It works by interfering with bacterial protein production, halting the growth and replication of bacteria.
Clindamycin can treat many skin and soft tissue infections, diabetic foot infections, bone and joint infections, lung infections, vaginal infections, and some infections inside the abdomen and pelvis. It also has some activity against certain nonbacterial pathogens such as malaria and toxoplasma.
How Clindamycin Works to Treat Acne
Clindamycin works against a type of skin bacteria called Cutibacterium acnes (C. acnes), which is closely linked to the development of acne.
In addition to its action against bacteria, clindamycin can suppress inflammation in the skin. Inflammation produces swelling and accumulation of material in skin pores, leading to the development of inflamed acne lesions.
Clindamycin can produce significant reductions in the number and severity of inflamed and noninflamed acne lesions. The best results are achieved when clindamycin is combined with another topical acne medication such as benzoyl peroxide, adapalene, or tretinoin.
A large analysis conducted by Harvard investigators included 23 clinical studies and compared clindamycin to benzoyl peroxide and clindamycin + benzoyl peroxide combination therapy. The following improvements in inflamed and noninflamed acne lesions were noted:
|Treatment||Mean reduction in inflamed lesions at 10-12 weeks||Mean reduction in noninflamed lesions at 10-12 weeks|
|Benzoyl peroxide alone||43.7%||30.9%|
|Clindamycin + benzoyl peroxide||55.6%||40.3%|
The American Academy of Dermatology recommends a combination therapy of topical clindamycin with benzoyl peroxide as a first-line treatment for mild acne. The combination of clindamycin with a topical retinoid (e.g., adapalene or tretinoin) or with oral antibiotics is recommended for moderate to severe acne.
How long does it take to work?
Many people will see improvements within two to six weeks.
The Harvard analysis showed that at two to four weeks, there was a 21.5% reduction in inflammatory acne lesions in people treated with clindamycin alone. Those who were treated with clindamycin + benzoyl peroxide experienced a 40.7% reduction.
Some people might take longer to see improvements. You should not stop the treatment on your own without first consulting your dermatologist.
Topical Clindamycin for Acne
Topical clindamycin is available in the form of gels (Cleocin-T, Clindagel), lotions (Cleocin-T), foams (Evoclin), solutions (Cleocin-T), and pledgets or medicated wipes (Clindacin ETZ, Clindacin-P, Cleocin-T). Generic forms are also available.
Compared to oral clindamycin, topical clindamycin has the benefit of limiting the drug’s effects to the skin. This is safer as it avoids some of the risks associated with systemic clindamycin therapy like antibiotic-associated diarrhea.
How to use it
Before applying topical clindamycin, thoroughly wash the affected area with soap and warm water then rinse and gently dry with a towel. After applying clindamycin, wash your hands to clean any residues.
If you are using clindamycin foam, spray the medication into the cap that covers the nozzle. Take small amounts from the cap on your fingertips and gently apply it to your skin. Keep massaging until the foam disappears.
The topical solution form of clindamycin comes in a bottle with an applicator tip. Gently press the applicator tip to your skin in a dabbing motion and repeat to cover the treatment area.
For lotions and gels, use your fingertips to spread a thin layer of the medication over the area.
If you are using medicated pads, gently wipe the skin with the pad then discard it. You can use more than one pad if the treatment area is large.
Most forms of topical clindamycin come in 1% concentration. Combination forms with tretinoin (Veltin, Ziana) contain 1.2% clindamycin and 0.025% tretinoin.
The foam form is typically used once a day. Topical gels, lotions, solutions, and pledgets are usually applied twice a day.
Oral Clindamycin for Acne
In the past, oral clindamycin was used in the treatment of acne vulgaris. Although effective, oral clindamycin is no longer recommended for acne due to the risk of causing dangerous side effects.
When taken by mouth, clindamycin can disturb the natural gut microbiome and cause an overgrowth of a type of bacteria called Clostridium difficile (C. diff). This can result in pseudomembranous colitis, an inflammation of the colon that can lead to serious complications such as perforation of the colon and can even be lethal in some cases.
Up to 21% of patients who take clindamycin can experience diarrhea. Colitis is seen in 2-10% of patients treated with clindamycin.
Side Effects and Risk Factors
Topical clindamycin is quite safe and its side effects are mild and self-resolving. Side effects can include skin dryness, redness, irritation, itching, and exfoliation. Although very rare, diarrhea and colitis were reported in a few cases following the use of topical clindamycin.
People who are allergic to clindamycin or lincomycin and those who have ulcerative colitis or a history of antibiotic-associated colitis should not take clindamycin.
Data on the safety of topical clindamycin during pregnancy and breastfeeding is lacking. Although breastfeeding and pregnant women can take clindamycin, they should avoid prolonged use of the medication.
The American Academy of Dermatology recommends that clindamycin always be used with other acne medications to reduce the risk of developing bacterial resistance to the antibiotic.
Topical antibiotic therapy is an important component in the treatment of acne. Benzoyl peroxide, erythromycin, dapsone, and minocycline are topical medications that can kill acne-causing bacteria.
Benzoyl peroxide can also reduce the production of irritating fatty acids and facilitate the drainage of stuck materials in comedones.
Erythromycin is a macrolide antibiotic with activity against C. acnes. Erythromycin and clindamycin have comparable effectiveness and safety, and are used similarly.
Topical dapsone is an antibiotic with moderate efficacy at treating acne lesions, particularly inflammatory ones. Dapsone may be more effective in women than in men.
Clindamycin is an antibiotic with activity against the acne-causing bacterium C. acnes. When used topically in combination with other acne medications like benzoyl peroxide and tretinoin, it can treat mild, moderate, or severe acne. The oral form of clindamycin is not used for acne treatment.
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