Tolerability and Efficacy of Clindamycin/Tretinoin versus Adapalene/Benzoyl Peroxide in the Treatment of Acne Vulgaris

March 2021 | Volume 20 | Issue 3 | Original Article | 295 | Copyright © March 2021


Published online January 26, 2021

Roland Aschoff a, Sebastian Möller a, Rocco Haase b, Marvin Kuske a

aDepartment of Dermatology, University Hospital Carl Gustav Carus,Technical University Dresden, Dresden, Germany
bCenter of Clinical Neuroscience, University Hospital Carl Gustav Carus,Technical University Dresden, Dresden, Germany

Abstract
Acne vulgaris is the most common dermatological disorder worldwide, causing significant physical and psychological morbidity. Topical combination therapy has shown superior efficacy compared to monotherapy, especially when combined with retinoids. Few studies have directly compared combined formulations. This evaluator-blinded pilot study compared the efficacy and tolerability of two marketed topical combination acne gels, clindamycin 1%-tretinoin 0.025% (CT) and benzoyl peroxide 2.5%-adapalene 0.1% (BA) in 20 patients with mild to moderate acne vulgaris. Gels were applied daily on opposite sides of the face for 21 days. The primary outcome was difference in transepidermal water loss (TEWL) at the end of treatment. Secondary endpoints were skin moisture content measurement, Investigators' Global Assessment, subject self-assessments (SSA) of burning/stinging, itching, erythema, and dryness/scaling, and Comparative Participant Satisfaction Questionnaire (CPSQ). Efficacy was assessed by inflammatory and non- inflammatory acne efflorescences counts. TEWL increased significantly for both CT and BA (+57.74%, P=0.002; +58.77%, P<0.001); skin moisture content significantly decreased only for BA (-16.47%, P=0.02). Only BA showed a significant increase in erythema and dryness/scaling (P=0.027 and P=0.014) and in SSA burning/stinging (P=0.04). Patient satisfaction evaluation also reflected the strong BA irritation. Although CT and BA both reduced acne lesions (P<0.001) and more patients preferred to continue with CT, subject perception of acne improvement was higher for BA. These findings suggest that CT and BA have similar efficacy in the treatment of mild to moderate papulopustular acne. However, CT was better tolerated than BA by both medical and subject evaluation. CT is an effective and tolerated treatment option.

J Drugs Dermatol.20(3):295-301. doi:10.36849/JDD.2021.5641

INTRODUCTION

Approximately 9% of the world's population suffer from acne vulgaris. It is the most widespread skin disease with a prevalence ranked eighth highest of all diseases worldwide.1 Quality of life (QoL) for patients with acne vulgaris is significantly reduced and comparable with that of patients with bronchial asthma, diabetes mellitus type 2, or chronic back pain.2 This suggests that substantial unmet treatment needs remain.

Along with the formation of comedones, inflammatory processes play an important pathogenic role in mild to moderate papulopustular acne. Combination therapy with different active substances such as topical antibiotics, keratolytics, and retinoids targets different pathogenic factors, resulting in a higher efficacy and improved compliance compared to monotherapy.3 Combination therapy, especially with retinoids, is recommended by several authors and guidelines for mild to moderate papulopustular acne.4-8

However, there is a lack of studies comparing the tolerability and efficacy of combination therapies.This pilot study aimed to compare the tolerability and efficacy of the fixed combination of clindamycin 1% and tretinoin 0.025% (Acnatac®- gel; MEDA Pharma GmbH & Co. KG, Bad Homburg, Germany) referred to hereafter as CT, with the fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% (Epiduo®- gel; Galderma Laboratorium GmbH, Düsseldorf, Germany) referred to as BA, in the treatment of mild to moderate papulopustular acne, using subjective and objective parameters and skin physiological measurements.

METHODS

Study Population
Twenty-two adolescents and adult subjects with mild to moderate acne vulgaris were enrolled in the study. Patient inclusion criteria were a diagnosed mild to moderate acne vulgaris at baseline (20–150 facial acne lesions, including 10–100 non-inflammatory and/or 10–50 inflammatory lesions and ≤2 cysts or lumps), skin type I to III according to Fitzpatrick Skin Phototype Classification,9 age between 14 and 50 years, willingness to participate in the study including screening sessions and follow-up evaluations, and general good physical and mental health.