Topical Clindamycin

Clindamycin is a lincosamide antibiotic that is bacteriostatic and works by inhibiting protein synthesis in sensitive bacteria. Its antibacterial spectrum includes Gram-positive bacteria, in particular the genera Staphylococcus and Streptococcus, and several of the anaerobic bacteria. Clindamycin also suppresses the complement-derived chemotaxis of polymorphonuclear leukocytes (in vitro), thereby reducing the inflammation potential [4]. Topical clindamycin 1%, which is widely used in the treatment of acne, is applied to affected areas once or twice daily. Absorption of topically administered 1% clindamycin is estimated to be 1-5% [5]. Adverse effects are mostly local: irritation, erythema, peeling, itching, dryness, and burning. As rare events, episodes of diarrhea and even two cases of pseudomembranous colitis have been reported after topical clindamycin treatment [6, 7].

One complication of the use of topical antibiotics is the development of bacterial resistance. The number of patients carrying Propionibacterium acnes and Staphylococcus epidermidis resistant to topical antibiotics has increased over the last few years. A potential risk is the transfer of resistance to other bacteria, specifically Streptococcus spp. and Staphylococcus aureus [4]. In acne therapy it is now often recommended to use topical antibiotics for shorter periods and preferably in combination with topical reti-noids, benzoyl peroxide or azelaic acid to enhance the efficacy and slow down the development of resistance [8].

The two randomized controlled trials referred to above [2, 3] have shown the effect of topical clindamycin used in mild or moderate cases of HS. The results of these studies fit well with the experience of more than 300 cases of HS treated at the Department of Dermatology, Karolinska Huddinge, Stockholm, Sweden. Clindamycin, preferably combined with azelaic acid, effectively suppresses acute exacerbations of at least milder forms of HS. The therapeutic effect of clindamycin on HS could be due to bac-teriostatic as well as anti-inflammatory effects. There are other commercially available topical antibiotics including erythromycin, mupirocin and neomycin, which probably have been tested for HS treatment although, to our knowledge, there are no published reports and their clinical effects on HS remain to be shown.

Acne Myths Uncovered

Acne Myths Uncovered

What is acne? Certainly, most of us know what it is, simply because we have had to experience it at one time or another in our lives. But, in case a definition is needed, here is a short one.

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