Topical clindamycin-tretinoin as an effective Tx option for acne for all skin types

Dr. Monica Li discusses combination therapy strategies for acne patients of all skin types. (765 words, 2.6 min)

Topical combination treatment options are now being recommended in North America and Europe as one of the first-line therapies for patients with acne across all skin types, said Dr. Monica K. Li during her presentation at Skin Spectrum Summit in Vancouver.

“If we look at phase III studies on the effectiveness of the combination of clindamycin with tretinoin across all skin types, we can see that are not only fairer-skinned patients doing very well with this medication but also those with skin types IV to VI,” said Dr. Li. 

“There are different synergistic and additive mechanisms of action when using a topical combination approach, which will then target multiple pathogenic factors underlying the progression of the acne,” said Dr. Li.

She said that the topical combination approach allows for better patient compliance.

“There are less ingredients and less products that [patients] have to use as part of their skincare and acne management,” said Dr. Li. A topical combination treatment can also help practitioners achieve desired treatment outcomes, according to Dr. Li, because of a higher likelihood of increased patient compliance. 

One of the most effective topical combination treatment options is a clindamycin-tretinoin gel (Bianca, Bausch Health).

During her presentation, Dr. Li discussed a clinical study that looked at the safety, efficacy and tolerability of clindamycin-tretinoin as a treatment option for acne. After a 12-week period, patients saw a significant reduction in papules and pustules, with results seen as early as two weeks. Compared to tretinoin alone, the combination treatment had a faster onset of action by six weeks. 

“Studies have shown that clindamycin can improve the effectiveness of retinoids,” said Dr. Li. “Topical retinoids can improve the penetration of other active agents, allowing for better concentration and penetration into the pilosebaceous unit, where the formation of the microcomedone first starts.” 

Dr. Li also talked about how combining a topical clindamycin-tretinoin gel with a benzoyl peroxide wash was an effective treatment option for a patient who was uncomfortable with systemic treatment options. 

The patient was a 43-year-old female with severe papulopustular acne on her face and upper back. “The severity of her presentation warranted a course of isotretinoin... This patient declined all of the systemic options because she was not comfortable with their potential side-effect profiles,” said Dr. Li. 

After four months, the patient had some papules and pustules but also showed significant improvement. According to Dr. Li, the take-home point from this case is that “benzoyl peroxide can be added to the combination of a topical clindamycin-tretinoin for a triple-modality approach where we are targeting different pathogenic factors underlying acne development.” 

The takeaway: The combination of clindamycin and tretinoin is effective in all skin types, including types IV to VI. 

Dr. Li’s presentation was supported through an unrestricted educational grant from Bausch Health. 

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FROM THE LITERATURE ON ACNE

Oral isotretinoin treatment in patients with acne vulgaris during the COVID‐19 pandemic: A retrospective cohort study in a tertiary care hospital

  • Compared to patients on topical acne treatments, patients on oral isotretinoin are not at increased risk of becoming infected by Covid-19, according to a recent study conducted by researchers in Turkey. Data from 227 patients was included in the retrospective cohort study; 141 were receiving treatment with isotretinoin, and 86 were receiving topical acne therapy, the authors wrote.

    From “Journal of Cosmetic Dermatology”

Assessment of skincare behaviour and cognition of patients with acne vulgaris in China

  • A research letter authored by researchers in China recommended that to avoid acne vulgaris flare-ups due to mask-wearing, patients should follow three steps. These steps include wiping their face with a moist towel containing a moisturizer, using cleansers with oil-controlling ingredients, and consulting their dermatologist when acne flares.

    From “Chinese Medical Journal”

A Retrospective Cohort Study and Clinical Classification System of Acne Keloidalis Nuchae

  • A study of patients of African and Hispanic descent proposed a classification scheme for acne keloidalis nuchae, making a note of the sagittal width for the various classes of presentation of the skin condition. The researchers noted that patients of African ancestry were at increased risk of developing tumorous masses.

    From “JCAD”

VIDEO: Patients on oral isotretinoin are not at increased risk of Covid-19 infection

AT THE INTERSECTION OF SKIN AND SOCIETY

  • This week, CBC launched a new series of essays, articles, podcasts, images, and videos titled Black on the Prairies, which examines what it means to be Black in Alberta, Saskatchewan and Manitoba. The series, overseen by a 10-person community advisory board, reflects a 200-year history of achievements, racism, politics, art, sports, migration, Black and Indigenous relations, and more. Story highlights include “The whitewashing of Prairie history,” “Prairie sounds,” a playlist of Black music makers in the Prairies, and “Black Prairie by the numbers,” which delves into Prairie population statistics. Explore the series here.

This Week

Something to think about during the week ahead…

Next Week

Dr. Andrew F Alexis talks about treating scalp psoriasis in women of African ancestry.

Thank you to our panellists and delegates for making the Indigenous Skin Spectrum Summit a great success. As always, we welcome your questions and comments on topics in Ethnodermatology.

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