Topical Clindamycin: A Safe Choice for Acne Treatment Despite GI Concerns

A recent review published in the Journal of Dermatological Treatment highlighted the safety of topical clindamycin, a popular antibiotic treatment for acne vulgaris (AV), amidst concerns regarding gastrointestinal (GI) adverse events (AEs). Often combined with benzoyl peroxide or retinoids, topical clindamycin has been scrutinized for its potential to cause GI issues, but new findings suggest these risks may be minimal in real-world applications.

The review analyzed safety data from published literature, worldwide pharmacovigilance databases, and 2 retrospective cohort studies. Remarkably, pharmacovigilance data revealed a GI adverse drug reaction rate of just 0.000045%—equating to 64 cases among over 141 million prescriptions for topical clindamycin-containing products. Additionally, 2 retrospective studies indicated that health care providers prescribed topical clindamycin to patients regardless of their inflammatory bowel disease history, reporting low rates of conditions like pseudomembranous colitis.

In 8 pivotal clinical trials focusing on topical clindamycin for AV, GI AEs were documented in only 1.4% of participants. The findings suggest that while warnings exist for oral and topical clindamycin, the incidence of colitis and other GI complications in patients using topical formulations is exceedingly low.

However, researchers caution that the study has limitations, including potential underreporting of AEs and issues with prescription data accuracy. Despite these concerns, the review underscores the favorable safety profile of topical clindamycin, offering reassurance to patients and health care providers alike regarding its use in acne treatment. As acne continues to affect millions worldwide, these insights may lead to broader acceptance and usage of topical clindamycin in dermatologic practice.

Reference
Pelet Del Toro NM, Strunk A, Wu JJ, et al. Topical clindamycin for acne vulgaris: analysis of gastrointestinal events. J Dermatolog Treat. 2024;35(1):2325603. doi:10.1080/09546634.2024.2325603