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Summary
Abstract
Clindamycin 1%/benzoyl peroxide 5% (BenzaClin®) is a combination gel indicated for use twice daily, or as directed by a physician, for the topical treatment of inflammatory and noninflammatory lesions of acne vulgaris. In well designed clinical trials in patients with mild to moderately severe acne, the efficacy of once- or twicedaily clindamycin/benzoyl peroxide in the reduction of inflammatory lesion counts was greater than that of benzoyl peroxide alone, clindamycin alone, or tretinoin plus clindamycin, and not significantly different from that of erythromycin/benzoyl peroxide. In the reduction of noninflammatory lesion counts, the efficacy of onceor twice-daily clindamycin/benzoyl peroxide was greater than that of clindamycin alone, but not significantly different to that observed with benzoyl peroxide, tretinoin plus clindamycin, or erythromycin/benzoyl peroxide. Clindamycin/benzoyl peroxide has a fairly rapid onset of action, with acne improvement usually recorded within 2-4 weeks. Despite widespread use, bacterial resistance is not associated with clindamycin/benzoyl peroxide. The product is generally well tolerated, and the main treatment-related adverse events in clinical trials were application-site dryness, irritation, peeling, and erythema. Thus, clindamycin/benzoyl peroxide is an effective and well tolerated option for the management of mild to moderately severe acne.
Pharmacologic Properties
Clindamycin and benzoyl peroxide are effective antibacterials, reducing the population of Propionibacterium acnes on the surface of the skin. The combination gel of clindamycin 1%/benzoyl peroxide 5% is significantly more effective in reducing P. acnes counts, and has a significantly faster onset of action, than clindamycin 1% alone. Despite widespread use, benzoyl peroxide is not associated with bacterial resistance, and when combined with clindamycin, it suppresses the emergence of clindamycin-resistant P. acnes relative to single-agent clindamycin.
Both agents also have anticomedogenic and anti-inflammatory effects. Clindamycin appears to have a direct effect on polymorphonuclear leukocytes (PMNs), whereas benzoyl peroxide inhibits the release of reactive oxygen species from PMNs.
Systemic exposure to clindamycin or benzoyl peroxide is minimal following topical application and neither agent accumulates in serum. Topical clindamycin phosphate is rapidly hydrolyzed to free clindamycin, and following multiple applications of a 1% solution, <0.2% of the unchanged drug was detected in the urine. Benzoyl peroxide is highly lipophilic and easily enters the lipid-rich sebaceous follicle. As it passes through the skin layers, it is metabolized to benzoic acid. About 3-4.5% of...