Comparison of Clindamycin 1% and Benzoyl Peroxide 5% Gel to a Novel Composition Containing Salicylic Acid, Capryloyl Salicylic Acid, HEPES, Glycolic Acid, Citric Acid, and Dioic Acid in the Treatment of Acne Vulgaris

Acne vulgaris is a physiological condition the detriments of which extend to the psychological and social aspects of those affected. It has been shown that individuals suffering from severe acne and its associated scarring may exhibit symptoms of depression, anxiety, or social withdrawal.¹ For these reasons, acne treatment is a more than $100-million-a-year industry.

The cause of acne vulgaris is not singular in any respect. A multisymptom/multipathway cascade involving both internal and external influences is a more accurate model. Research indicates pathophysiology that includes sebaceous gland hyperactivity, changes in follicular keratinization, influence of the bacteria Propionibacterium acnes, and also a paracrine effect influencing inflammation.^2,3 Because of these implications, several combination therapies have been studied in order to address the various causes of acne simultaneously. Included in these techniques are combinations that involve 2 or more of the following: retinoids, antibiotics, laser treatments, light treatments, benzoyl peroxide (BPO), salicylic acid (SA), and glycolic acid among others.^4,5

The current study comprised a split-face model comparing the efficacy and tolerability of clindamycin 1% and BPO 5% gel (BenzaClin ®; Valeant Pharmaceuticals International, Inc, Montreal, Quebec; treatment B) with a novel combination treatment for acne vulgaris (treatment A). The combination of 1% clindamycin and 5% BPO has been shown to be efficacious in treating acne vulgaris through its antibacterial, anticomedogenic, and anti-inflammatory effects.⁶ Treatment A is a nonprescription composition containing SA, capryloyl salicylic acid (LHA), N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES), glycolic acid, citric acid, and dioic acid designed to be a daily use treatment for acne and antiaging. SA has been shown to be effective against acne as a comedolytic.⁷ Evidence of allergic reaction, dryness, and erythema is present in the literature.⁶ LHA has been shown to be an efficient keratolytic agent that compared with SA more specifically targets corneodesmosomes between corneocytes, which leads to a more even exfoliation. In addition, LHA has been shown to be beneficial in reducing the signs of skin aging and has anti-inflammatory functions.⁸ HEPES stimulates protease activity in the stratum corneum, promoting desquamation. Glycolic and citric acids are members of the α-hydroxy acids (AHAs), which are known to promote exfoliation. Dioic acid is a naturally derived botanical ingredient shown to reduce sebum and P acnes proliferation. It also has anti-inflammatory effects, stimulates peroxisome proliferator–activated receptors, and may prevent hyperpigmentation.⁹

The final study population of 28 subjects completed the 8-week trial. Males and females between the ages of 18 and 40 years were recruited for participation from Miami-Dade County and surrounding areas. The average age was 26 ± 4.87 years. Individuals were clinically determined to have mild to moderate