|Year : 1990 | Volume
| Issue : 5 | Page : 377-380
Topical clindamycin hydrochloride 1% in acne vulgaris
Vaswani N Khanna
Vaswani N Khanna
Source of Support: None, Conflict of Interest: None
Twenty six patients with moderately severe acne were treated for 12 weeks with topical clindamycin hydrochloride 1% (12 patients) and the vehicle (14 patients). A good or excellent reduction was seen in the non-inflammatory acne lesion count in 3 (25%) of the patients on topical clindamycin and in none of the patients who used the vehicle (control).While 9 (75%) of the patients using topical clindamycin hydrochloride showed a good to excellent response in their inflammatory acne lesion count, only 2 (14.29%) of the control group showed a similar response. The response of the non-inflammatory acne to topical clindamycin hydrochloride 1% was comparable to that of the vehicle, (p >0.05) while the response of inflammatory acne lesions to topical clindamycin hydrochloride 1% was superior to that of the vehicle (p <0.05)
Keywords: Acne vulgaris, Clindamycin hydrochloride
|How to cite this article:|
Khanna VN. Topical clindamycin hydrochloride 1% in acne vulgaris. Indian J Dermatol Venereol Leprol 1990;56:377-80
Though the role of Propionibacterium acnes > in the comedogenic phase of acne vulgaris remains controversial, its role in inflammatory acne is almost universally accepted. Measures aimed at reducing P. acnes population in the sebaceous follicles have been widely used for the management of acne. Though systemic antibiotics have been employed for several years, during the last decade topical antibiotics have become more acceptable for treating acne, because they have fewer side effects and drug interactions than oral antibiotics.
A number of topical antibiotics have been tried in acne vulgaris, but erythromycin and clindamycin preparations are the most popular. Stoughton and Resh did the first definitive work with topical clindamycin in acne vulgaris. It has been found to be as effective as systemic tetracyclines, topical erythromycin, and topical benzoyl peroxide. Clindamycin penetrates the skin and retains its biological activity against P. acnes even in contact with skin. The concentration of clindamycin in the comedonal material is more than sufficient to suppress the growth of P.acnes. There is a concurrent reduction in the free fatty acid levels on the skin surface.
Though topical antibiotics have been used extensively in the treatment of acne in the West, their use in India had been limited till recently, to a large extent by the non-availability of these topical preparations. Though the successful use of topical erythromycin in acne vulgaris has been demonstrated by Vaswani et al to the best of our knowledge, this is the first report of the use of clindamycin topically in acne vulgaris from India.
| Materials and methods|| |
A double-blind, randomised 12-week study was conducted to evaluate the efficacy in acne vulgaris of clindamycin hydrochloride 1 % in an hydro-alcoholic vehicle as compared to the vehicle used alone. The study population was made up of 29 patients, aged 14-23 years, with moderately severe acne vulgaris. Moderately severe acne was defined as the presence, on the face (above the jawline) of the subject, of 5-15 inflammatory lesions (IN) but no more than 5 nodulocystic lesions and / or more than 50 non-inflammatory (NI) acne lesions. None of the patients had received any anti-acne therapy within the previous 30 days and none of the female patients taken up for the trial, were taking any oral contraceptives or were pregnant.
Patients were randomly assigned to one of the two treatment schedules (a) clindamycin hydrochloride 1% in a hydro-alcoholic vehicle to be applied topically twice a day (b) the hydroalcoholic vehicle to be applied topically twice a day (used as a control).
The efficacy of the drugs was evaluated at four weekly intervals by spot counting of the acne lesions, done by the same observer. The criteria for effectiveness of the treatment was the reduction in the number of NI and IN lesions at the end of 12 weeks. The improvement was graded as follows : (1) excellent, when there was more than 75% reduction in the lesion count, (2) good, when there was 50-75% reduction in the lesion count, (3) fair, when there was a 25-50% reduction in the lesion count , (4) poor, when there was less than 25% reduction in the lesion count, and (5) worse, when there was an increase in the lesion count.
In addition the mean reduction of the NI and IN lesions was calculated for each of the two therapeutic groups. The response was statistically evaluated using a paired t-test. A p value of < 0.05 were considered statistically significant.
| Results|| |
A total of 29 (19 males and 10 femal6s) patients were taken up for the study. Twenty six ( 12 using topical clindamycin hydrochloride 1% and 14 using the vehicle) could be followed up for the stipulated 12 weeks. The clinical response of the NI and IN lesions of acne vulgaris to topical clindamycin hydrochloride 1 and to the vehicle, when used alone, is depicted in [Table - 1][Table - 2]. The response of IN acne lesions to topical clindamycin hydrochloride 1% was superior to that if the hydro-alcoholic vehicle and this difference was statistically significant (p=0.007). Though it seemed that NI acne lesions also responded to topical clindamycin hydrochloride 1%, there was statistically no significant difference in this response, when compared to the response with the vehicle (p=0.65).
Side effects were observed in 2/12 (16.67%) patients using topical clindamycin hydrochloride and in 3/14 (21.43%) patients using the vehicle. These patients developed mild burning, dryness, erythema, itching and peeling of the skin. None of these side effects were severe enough to necessitate withdrawal of therapy. None of the patients using clindamycin topically developed any gastrointestinal side effects.
| Comments|| |
Stoughton and Resh showed that topical clindamycin improved acne vulgaris, as well as decreased or totally eliminated recoverable P. acnes from open comedones. It also inhibited the production of free fatty acids, a possible mediator of inflammation in acne vulgarise. On the other hand, neither topical erythromycin nor topical tetracycline significantly suppressed P. acnes in the open comedones.
Shalita et al in a multicenter trial found that 62% of the 80 patients treated with topical clindamycin phosphate 1 % had a good or excellent response. The number of NI and IN lesions were reduced by 39% and 59% respectively. Similar results were reported by Katsambas et al, Leyden et al and Tucker et a1. In the present study, 9 (75%) of the 12 patients on topical clindamycin hydrochloride 10% showed a good or an excellent response in the IN lesions, while only 2 (14.29%) of the control group showed a similar response. The mean reduction in the IN acne lesions in the group using topical clindamycin was greater than in the control group and this difference was statistically significant (p<0.05). The response in the IN acne lesions seen in this study was similar-to that seen by earlier workers,,,,. On the other hand, though the mean reduction in the NI acne lesions was also greater in the group using topical clindamycin than in the control group, this difference was not statistically significant. The response of NI acne lesions in this study is at a variance with many of the earlier reports,,,,, where the NI lesions had also responded significantly to topical clindamycin phosphate, but supports the views of Mills et al.
Side effects were seen in 12 (13%) of the 80 patients treated with 1% clindamycin phosphate by Shalita et a1. None of these patients had gastrointestinal symptoms. Other studies,, have also reported a similar incidence of side effects. Two (16.67%) of the 12 patients on topical clindamycin hydrochloride 1% in this study developed local side effects. None of the patients developed any gastrointestinal symptoms. The incidence and type of side effects in this study was similar to that seen by other workers,,.
| References|| |
|1.||Puhvel SM: Pro Pionibacterium acnes and acne vulgaris, Seminars Dermatol, 1982; 1: 293-298. |
|2.||Stoughton RB: Topical antibiotics and acne, Seminars Dermatol, 1982; 1: 251-256. |
|3.||Stoughton RB and Resh W: Topical clindamycin in the control of acne vulgaris, Cutis, 1976; 17: 551 554. |
|4.||Katsambas A, Towarky AA and Stratigos J: Topical clindamycin phosphate compared with oral tetracycline in the treatment of acne vulgaris, Brit J Dermatol, 1987; 116: 387-391. |
|5.||Shalita AR, Smith EB and Baeur E: Topical erythromycin versus clindamycin therapy for acne. Multicenter, double blind comparison, Arch Dermatol, 1984; 120: 351-355. |
|6.||Leyden JJ, Shalita AR, Saatjian GD et al; Erythromycin 2% gel in comparison with clindamycin phosphate 1% solution in acne vulgaris, J Amer Acad Dermatol, 1987; 16: 822-827. |
|7.||Tucker SB, Tausend R, Cochrane R et al: Comparison of topical clindamycin phosphate, benzoyl peroxide and a combination of the two for treatment of acne vulgaris. Brit J Dermatol, 1984; 110: 487-492. |
|8.||Guin JD, Reynolds R, Gielerak PL: Penetration of topical clindamycin into comedones. J Amer Acad dermatol, 1980; 3: 153-156. |
|9.||Thompson RJ, Stranieri A, Knutson D et al: Topical clindamycin treatment of acne - clinical, surface lipid composition and quantitative surface microbiology response. Arch Dermatol, 1980; 116: 1031. |
|10.||Vaswani N, Pandhi RK, Bhutani LK et al: Topical therapy of acne vulgaris with retinoic acid and erythromycin lotion, Ind J Dermatol Venereol Leprol, 1989;55: 230-233. |
|11.||Mills OH and Kligman AM: Therapeutic options in the management of acne and its variants, Seminars Dermatol, 1982; 1: 233-238. |
[Table - 1], [Table - 2]
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