27. Clindamycin - the topical antibiotic of choice
Doctor Jacob here, and in today's episode we're going to be talking about clindamycin, the topical antibiotic of choice for acne.
So clindamycin is a wonderful addition for acne topical treatment regimens, for people with inflamed acne. So not just clogged pores, but where the inflammation has progressed a little bit and there are papules or red bumps, or pustules, which are pimples or zits. So clindamycin is helpful in these cases.
It can be sometimes used as an adjunct treatment for patients with more severe, deeper seeded cystic acne. It's not really my treatment of choice for hormonal acne.
Let's talk about clindamycin and how it can be added to an acne therapeutic regimen. If you haven't already had a chance, please go back and catch the previous episodes on retinoids and benzoyl peroxide, so that we can build upon it here.
Retinoids and benzoyl peroxide are both irritants to the skin. What does that mean? That means as you put them on in higher and higher concentrations, or higher and higher frequencies of application, the skin gets more and more irritated. There is a narrow therapeutic window for both of these drugs, meaning that if you use them too much the patient gets into trouble, peeling a little bit of what we call a red peel for retinoids, or with a little bit of inflammation, peeling, flaking and dryness, or a white peel with benzoyl peroxide with kind of white flaking if you use too much of it.
Clindamycin doesn't have that problem, so it's great to add to a regimen, especially for somebody who has sensitive skin, dry skin or eczema-prone skin, and wonderful in a situation where there is some inflammation with the acne, with those papules or pimples or pustules, which are zits. So for patients with just purely comedonal acne, that's just the clogged pores, topical clindamycin is pretty much not needed.
Okay, let's talk about side effects. Most people have zero side effects with clindamycin. Anybody can become allergic to any drugs, so aside from that it's rare for anybody to have side effects. This is because we're treating a limited surface area of the body in most cases - sometimes the face, the face plus the shoulders, maybe even a little bit on the chest or upper back, but we're not treating the entire torso or 50% of the body surface area twice a day.
If you use it like that, where you're treating such a large surface area, then you can start getting a bit of systemic absorption of the drug, where you can have some side effects of gastrointestinal issues such as loose stools, diarrhea or even antibiotic-associated diarrhea with a bacteria called Clostridium difficile. Again, extremely rare in limited use, which is the scenarios in which most patients are receiving clindamycin.
It is a prescription substance and it is absolutely safe to use in pregnancy and during breastfeeding as a topical medical.
So how is clindamycin available? It comes with a couple of combination products as you may guess, with benzoyl peroxide and with tretinoin. We'll get to that in just a moment, but plain clindamycin is available as a lotion, as a swab or pledget and as a solution. Clindamycin is also available as a gel, although I rarely prescribe the gel for treatment of acne.
I recommend for most patients who have normal or slightly dry skin to take the lotion, because the lotion can help balance the dryness coming from the topical retinoids or topical benzoyl peroxide products. The solution is an alcohol-based solution; it sometimes can sting. For guys who like an after-shave, which is alcohol based, I sometimes prescribe it, but for most patients, unless you're really oily, in which the solution would be better, I think that most patients will do better with the clindamycin lotion, so I usually use that as a go-to product.
In terms of combination products, we'll talk more about combination products in our next episode, but suffice to say that it's really convenient for clindamycin to be combined with either benzoyl peroxide or with tretinoin, a retinoid, and it's great, it helps people apply it without having to worry about putting two different creams on. I frequently prescribe clindamycin as a combination product, so look forward to the next episode for more details about that.
Next let's talk about other topical antibiotics which have been used for acne, but which are no longer in favor.
Erythromycin was once the most commonly prescribed antibacterial agent for acne. It was prescribed topically. Unfortunately, bacterial resistance is now widespread for propionibacterium acnes, which is the acne causing bacteria, to erythromycin, so therefore it's fallen out of use. Unfortunately, the same is slowly by slowly happening to clindamycin, where it just doesn't work like it used to because bacteria that cause acne are becoming more and more resistant to it over time. Therefore I try to limit my use of clindamycin topically to patients that have papular or pustular acne, inflammatory acne, like was mentioned earlier in this episode.
Finally, I do not recommend Neosporin, bacitracin or Polysporin - these are over-the-counter antibacterials for use in acne. They just don't work. They're not the right drugs to target the right bacteria that trigger acne.
On a final note, I do not recommend oral clindamycin, which are pills of clindamycin, for the treatment of acne. Way too many side effects, we're going to go into that on a different episode, but certainly do not take oral clindamycin for acne.
That's it for today. I'm Doctor Jacob, see you next time.
Mild Acne - Moderate Acne - Severe (Cystic) Acne - Hormonal Acne - Acne During Pregnancy - Acne & Breastfeeding - Retinol - Anti-acne Cleanser - Anti-acne Toner - Benzoyl Peroxide - Zinc Monomethionine & Fish Oil - Pimple Spot Treatment - Blemish Treatment - Scar Treatment - Sunscreen - Moisturizer - Avoiding Exacerbators - Comedogenic Ingredient List - Azelaic Acid - Birth Control Pills - Clindamycin - Doxycycline - Isotretinoin - iPledge - Spironolactone - Minocycline - Bactrim (SMX/TMP)