INTRODUCTION
Acne vulgaris (AV) is a common skin disorder, affecting almost 100% of adolescents at some point1 and persisting in over 60% and 40% of individuals in their 20s and 30s, respectively.2 In the United States, AV is the most common inflammatory skin condition and among the 5 most common reasons for visiting a dermatologist.3,4 Patients with AV may present with visible manifestations associated with active lesion formation such as comedones, papules, pustules, and nodules, and/or with potential sequelae after active lesions have resolved, such as scarring, persistent hyperpigmentation, and persistent erythema.5 AV can also negatively alter self-perception and the ways that affected individuals are perceived by others,6 with an increased risk of anxiety, depression, and suicidal ideation.7 Thus, the psychological effects of AV can be profound in some individuals, dramatically impairing quality of life and self-esteem in patients of all ages.
AV is a primary inflammatory disease involving the pilosebaceous unit. Its pathophysiology is multifactorial and includes 4 interrelated factors: follicular hyperkeratinization and obstruction, increased sebum production induced by androgens, proliferation of Cutibacterium acnes (formerly Propionibacterium acnes), and inflammation produced by a variety of pathways.8 Effective AV treatment incorporates therapeutic agents that target these pathophysiologic mechanisms with oral and/or topical pharmacologic treatments. Prescription topical medications include antibiotics (eg, clindamycin, erythromycin, minocycline) that can reduce C. acnes and/or induce anti-inflammatory effects in some cases; benzoyl peroxide (BPO), an antibacterial agent that directly reduces C. acnes through direct oxidative mechanisms and comedolytic properties; and retinoids (eg, adapalene, tazarotene, tretinoin, and trifarotene), which impair corneocyte adhesion with reduction in comedone formation, and induce direct anti-inflammatory effects such as downregulation of Toll-like receptors (TLRs) that interact with C. acnes.9-11 Clinical presentation, severity, and patient characteristics (eg, inherent motivation for treatment, age, skin color, skin type [dry, oily], psychosocial impact, adherence-related factors, prior sensitivities or allergies) should be considered in treatment selection,12 as complex regimens, poor efficacy, poorly-designed formulations, and adverse events can negatively impact treatment adherence and effectiveness.13
Clindamycin is a semi-synthetic lincosamide antibiotic that has been commonly used for the treatment of AV for almost 5 decades, primarily as a topical agent.14,15 Although it is
AV is a primary inflammatory disease involving the pilosebaceous unit. Its pathophysiology is multifactorial and includes 4 interrelated factors: follicular hyperkeratinization and obstruction, increased sebum production induced by androgens, proliferation of Cutibacterium acnes (formerly Propionibacterium acnes), and inflammation produced by a variety of pathways.8 Effective AV treatment incorporates therapeutic agents that target these pathophysiologic mechanisms with oral and/or topical pharmacologic treatments. Prescription topical medications include antibiotics (eg, clindamycin, erythromycin, minocycline) that can reduce C. acnes and/or induce anti-inflammatory effects in some cases; benzoyl peroxide (BPO), an antibacterial agent that directly reduces C. acnes through direct oxidative mechanisms and comedolytic properties; and retinoids (eg, adapalene, tazarotene, tretinoin, and trifarotene), which impair corneocyte adhesion with reduction in comedone formation, and induce direct anti-inflammatory effects such as downregulation of Toll-like receptors (TLRs) that interact with C. acnes.9-11 Clinical presentation, severity, and patient characteristics (eg, inherent motivation for treatment, age, skin color, skin type [dry, oily], psychosocial impact, adherence-related factors, prior sensitivities or allergies) should be considered in treatment selection,12 as complex regimens, poor efficacy, poorly-designed formulations, and adverse events can negatively impact treatment adherence and effectiveness.13
Clindamycin is a semi-synthetic lincosamide antibiotic that has been commonly used for the treatment of AV for almost 5 decades, primarily as a topical agent.14,15 Although it is
