Combination creams for acne-with an antibiotic or a weak retinoid?

Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris.

Zouboulis CC, Fischer TC, Wohlrab J, Barnard J, Alió AB.

Cutis. 2009 Oct;84(4):223-9.

Combination creams for the treatment of moderate acne vulgaris are the new trend in therapeutic dermatology. The big issue of these products has been the duration of a stable (=active) compound. We observe the following study which deals with the efficacy, tolerability ans safety of combination creams in the treatment of moderate facial acne.

The compared fixed-dose combination gels were:

1. clindamycin 1%-benzoyl peroxide 5% gel with hydrating excipients (C/BPO HE)
2. adapalene 0.1%-benzoyl peroxide 25% gel (A/BPO).

Results:

• After 12 weeks of once daily treatment, the mean reduction in inflammatory lesion count was:

1. approx. 77% in the C/BPO HE group
2. approx 72% in theA/BPO group (P = .076).

• Significantly more participants achieved treatment success ( improvement of 2 grades or more from baseline to week 12 on the investigator’s static global assessment (ISGA) scale)

1. approx. 31% (58/190 patients) in the C/BPO HE group
2. approx. 22% (42/192) in the A/BPO group (P = .046),

• Treatment success was achieved more quickly with C/BPO HE (P = .035).
• Both products also reduced noninflammatory (approx. 62% for C/BPO HE and A/BPO) and total lesion counts (approx69% C/BPO HE vs 67% A/BPO).
• Despite the overall similar efficacy profile, C/BPO HE was better tolerated and safer than A/BPO.

1. erythema, dryness, peeling, pruritus, and burning/ stinging were more frequent in the A/BPO group at all time points from week 1 onward (P < .05).
2. Treatment-related adverse events (AEs) occurred in approx. 48% (92/190) of participants in the C/BPO HE group compared with approx. 79% (151/192) of the A/BPO group.

The authors conclude that both combination gels are effective in the treatment of inflammatory and non inflammatory lesions in moderate acne (slightly inflammatory), but this prospective study demonstates that C/BPO HE acts faster, is better tolerated and is safer than A/BPO. We wish to add that more studies will be needed to prove the conclusions of this study in a definate way.