If you suffer from acne which isn’t responding completely to any single medication, then clindamycin and tretinoin form one of the most frequently used combinations, as opposed to some other ingredient combinations, which might be questioned online; this one does have a good scientific basis for its use. The fact is that the two medications act on acne in entirely different ways, and that is why they are usually combined.
Here, you will learn how each of the medications acts and why they can be effectively combined, how the combination is normally prescribed, and some information on potential side effects and the safety of their use.
What Each Medication Does
Clindamycin
Clindamycin is an antibiotic, used topically, that attacks Cutibacterium acnes (previously called Propionibacterium acnes) bacteria that cause acne. As it decreases bacteria levels in the skin, it also helps to decrease inflammation and redness, as well as the number of active acne spots. This medication is considered to be one of the safest treatments available, with only minor side effects like dryness and/or redness that go away over time.
Tretinoin
As it was explained at length on our website, tretinoin acts in a completely different way – it increases skin cell turnover and prevents clogged pores (comedones) that appear as blackheads and whiteheads. Therefore, tretinoin is effective against comedonal acne that can’t be treated with antibiotics like clindamycin.
Why This Combination Makes Clinical Sense
Acne is never caused by a single problem, but rather by the combination of clogged pores, excessive amounts of oil, bacterial infection, and inflammation. Since clindamycin and tretinoin target different stages of the process, their combination can provide much more comprehensive treatment of acne than either of the drugs individually:
- Tretinoin unclogs the pores and removes the non-inflammatory lesions, which are known as comedonal acne.
- Clindamycin targets the bacteria and inflammation, causing inflammatory acne.
Indeed, there is scientific proof for such a complementary therapy: an analysis of a study conducted over 12 weeks comparing the treatment effectiveness of clindamycin and clindamycin/tretinoin combination has shown that patients receiving the combination treatment had a higher treatment success score than those using only clindamycin. There is one more advantage of such treatment: since tretinoin is known for causing skin irritation at first, there is scientific proof that the use of clindamycin in conjunction with tretinoin can help alleviate that irritation.
How This Combination Is Typically Prescribed
Combination Gel or Cream
A combination of products, including both clindamycin phosphate and tretinoin in a single product is used by many dermatologists to be applied in a once-a-day application.
Separate Products, Different Times of Day
Some doctors use the combination of separate products to be applied differently at different time of day. For example, clindamycin is recommended to be applied in the morning while tretinoin is prescribed to be applied at night. This way there will be less interaction of these two products.
Standard Application Technique
No matter what form your dermatologist suggests, the basic principles of use are similar in accordance with recommendations for using tretinoin:
- Wash your face softly and let it dry completely for some minutes before applying.
- A pea-size dose of it should be used all over the face including areas without any breakout spots – this is how you usually apply both tretinoin and the clindamycin-tretinoin combo.
- Apply at the same hour of night, usually at bedtime for combos.
- Don’t put on the eyes, mouth area, nostrils and lips. Also, avoid using it on damaged, sunburned or irritated skin.
- Use a moisturizer after the tretinoin to minimize dryness; you may choose the one that contains niacinamide for additional decrease of irritations.
- Apply it constantly for the whole period as prescribed – sometimes no immediate effect can be seen because acne treatment takes several weeks to give an effect.
How Long Until You See Results?
As is the case with many treatments for acne, patience is key here. The majority of those who try this treatment will have to give it a few weeks to a few months to work, and often a dermatologist will advise the patient to complete the entire prescribed course of treatment, “even if you feel like it isn’t working,” because quitting prematurely is the main reason acne treatments seem ineffective.
Potential Side Effects
This combination contains two active drugs, and the side effects may be caused by either one of them individually:
- Dryness, flakiness, and peeling – mainly because of the presence of tretinoin, especially in the beginning period
- Redness and irritation – may be caused by both drugs, usually disappearing when the skin gets used to them
- Burning or stinging feeling upon application, especially at the beginning of treatment
- Photosensitivity – another consequence of using tretinoin, necessitating daily use of sunscreen
The topical clindamycin, in particular, has a rather low incidence rate of side effects – mild redness and dry skin – and this is one of the reasons why this drug can be combined reasonably well with tretinoin instead of combining it with some other acne ingredients.
An allergic reaction, such as hives, breathing difficulties, swelling of the face, mouth, tongue, and throat, would require immediate medical help and is different from normal skin irritation that may be experienced while using this combination.
What to Avoid Combining With This Treatment
While clindamycin and tretinoin form an effective combination, it is not necessary to add other active ingredients to it, as it leads to unnecessary irritation. In most cases, it is better not to combine:
- Benzoyl peroxide with this combination, since it may interact with tretinoin and decrease its efficacy when used together (although there are special combinations designed to overcome this effect)
- Salicylic acid and other aggressive peeling agents, which only add to the irritative effect of tretinoin, which has its own exfoliation properties
- Other retinoids, because the addition of multiple retinoids to the regimen does not provide any additional effect, but only causes increased irritation
If your regimen includes the use of benzoyl peroxide, your dermatologist will help you combine it with other products properly, as sometimes multiple active ingredients are needed to treat resistant acne.
Who This Combination Is Typically Prescribed For
- Those who have a combination of inflammatory and comedonal acne, which tackles both problems at once.
- Those who have not seen enough improvement from using one topical product alone.
- Individuals with moderately severe cases of acne, where using a combined method could decrease the amount of oral antibiotic use.
Individuals for whom their dermatologist feels that combining these two easily tolerated products will yield better results than using only one of them.
In severe cases of cystic or treatment-resistant acne, a visit to the dermatologist would be advised, as an alternative treatment plan would probably be required.
Precautions and Considerations
- Pregnancy: Tretinoin should not be used during pregnancy, including any combination with tretinoin. If you are pregnant or trying to conceive, discuss alternative treatment options with your physician.
- Sensitive skin: Sensitive skin might require starting out with a low concentration preparation and then using it every other night at first, instead of once a day right away.
- Antibiotic resistance issues: Clindamycin is an antibiotic; therefore, there are some combinations of clindamycin and benzoyl peroxide used to prevent the development of bacterial resistance during long-term usage. It is necessary to consider this fact when visiting your dermatologist for such treatment.
How This Compares to Other Acne Combination Therapies
There are, however, other possible combination therapies in the field of dermatology, which makes it clear that the above-mentioned drug is just one out of many options:
- Clindamycin + benzoyl peroxide: A fairly common option, which is mostly selected to prevent the development of resistance due to the bactericidal effects of benzoyl peroxide, and not to benefit from tretinoin. This type of therapy is less efficient in dealing with blackheads and whiteheads compared to the regimen containing tretinoin.
- Adapalene + benzoyl peroxide: Adapalene is another form of retinoid, available over the counter; the combination is chosen due to the milder effects of adapalene on the skin.
- Triple combination therapy (clindamycin + adapalene/tretinoin + benzoyl peroxide): In case of resistant forms of acne, a combination of three agents might be required.
- Oral antibiotics + topical tretinoin: For cases of extensive acne, oral antibiotics can be prescribed along with topical tretinoin in order to overcome the limitations of the topical clindamycin.
The location of your acne along the severity scale, ranging from mild-moderate and mixed inflammation and comedones, to something more severe or resistant, is precisely the type of evaluation that your dermatologist will make in order to decide if clindamycin-tretinoin alone would be sufficient or if another approach is needed.
Final Thoughts
The combination of clindamycin and tretinoin is indeed an optimal one, which attacks the condition from both fronts, bacterial and inflammation with the former, and pore unblocking and skin renewal with the latter. Clinical studies confirm the effectiveness of the combination therapy in terms of improvement compared to each of the drugs separately, and even more surprisingly, in making the adjustment period for the latter more tolerable.
As in any other prescription treatment of acne, it is all about persistence in usage, proper technique and some patience for the few weeks it will take before the results start to become visible. In case your acne has not been effectively treated by a single therapy, this combination might be worth trying next.
Frequently Asked Questions
Can I use clindamycin and tretinoin together every night?
It is typical for many combo treatments to be designed for daily application; however, people with sensitive skin usually need to start using them every other day and then increase their usage frequency gradually.
Does clindamycin reduce tretinoin’s irritation?
There is some information about how this drug can help to increase the tolerance of tretinoin when used in this combination, although personal experience may vary, and correct treatment (frequency of application, moisturizer, and sunscreen) remains important either way.
How long does it take to see results from this combination?
Usually, people have to wait for several weeks or even months of treatment before achieving noticeable effects – stopping treatment too soon is one of the most frequent reasons why this combination seems ineffective.
Can I use benzoyl peroxide with clindamycin and tretinoin?
This will need the input of your dermatologist because benzoyl peroxide may affect how effective tretinoin is, even though it may be used in an acne regimen in some cases to prevent antibiotic resistance.
Is this combination safe for sensitive skin?
It can be, with a more cautious introduction – starting with a lower concentration and less frequent application, then increasing as tolerated, rather than beginning with nightly use at a standard strength.
