Clindamycin

Clindamycin is a prescription antibiotic that stops bacteria multiplying, which makes it a useful treatment for the inflamed spots of acne. In the UK it comes in two topical forms, either as a licensed or compounded treatment. Licensed products are fixed lotions or gels containing Clindamycin either on its own or in combination with Tretinoin or benzoyl peroxide. Compounded formulas are unlicensed medicines made individually for each patient by a specialist pharmacy. Here your doctor can select the strength of Clindamycin and combine it with other acne-treating actives based on what your skin needs.

What Is Clindamycin and How Does It Work?

Used topically on the skin, Clindamycin prevents the acne-causing bacteria (Cutibacterium acnes) from growing or dividing, which reduces their number. It does this by binding to the 50S subunit of the bacterial ribosome, the machinery bacteria use to build proteins. It is predominantly bacteriostatic, holding bacteria in check rather than destroying them. Clindamycin also settles inflammation because C. acnes makes an enzyme that splits the oil in your pores into free fatty acids which cause irritation and pore-blocking, and so fewer bacteria means less of this. Overall, topical Clindamycin may provide the following benefits:

• Papules and pustules: the raised, inflamed spots of acne, which settle as the bacteria and the free fatty acids they generate come down.
• Acne on the body: can be used on the face as well as the back, chest and shoulders.
• Works alongside other actives: Clindamycin treats the bacterial driver, leaving actives like Tretinoin to clear blocked pores, Spironolactone to control oil and Azelaic acid to calm inflammation by a different route.

Despite its benefits, C. acnes can also become resistant to Clindamycin by changing the exact spot on the ribosome where Clindamycin binds. This is why, like most antibiotics, it is prescribed in defined courses and alongside an active that reaches acne another way.

How City Skin Clinic Uses Clindamycin

We use Clindamycin in our custom acne treatments, as a cream or a gel for suitable patients. Clindamycin is rarely the only active in an acne formula because pairing it with actives that tackle the other drivers of acne improves the result. It also reduces the chance of acne relapse when the Clindamycin course ends. Your doctor may combine Clindamycin with one or more of the following:

• Tretinoin: speeds up cell turnover, smooths texture, treats acne and fades pigment faster. It clears the blocked pores Clindamycin cannot reach, which is why the two are licensed together as a fixed product.
• Azelaic acid: calms inflammation, targets acne-causing bacteria and helps fade the marks breakouts leave behind, whilst not being an antibiotic.
• Niacinamide: supports the barrier, minimises pores and helps fade hyperpigmentation.
• Spironolactone: blocks the androgens driving oil production in hormonal acne.
• Hydroquinone: the strongest pigment suppressor we use to treat hyperpigmentation, melasma and age spots. Added where acne has left dark marks behind, in limited courses with breaks.

Benzoyl peroxide is the other common partner, and it reduces the emergence of bacteria resistant to Clindamycin, which is why the licensed combination gels pair the two. We do not compound with benzoyl peroxide but it is available in licensed formulas like Duac which your GP and a number of skin clinics may be able to provide.

How Do You Get Clindamycin in the UK?

Clindamycin is prescription only in the UK, in every form and at every strength. You cannot buy it over the counter. There are nine licensed topical Clindamycin products all at 1% strength. Three of these contain Clindamycin on its own, as a lotion or a gel. The other six are fixed combinations, five pairing Clindamycin with benzoyl peroxide (Duac) and one pairing it with Tretinoin (Treclin). Clindamycin is also available in compounded formulas which are unlicensed prescription treatments made individually for each patient by a specialist pharmacy. Your doctor can customise your formula by compounding Clindamycin with other actives if needed and choosing a cream or a gel base depending on your skin’s needs.

To access our custom skin treatments, you will need to complete the online consultation form or book a virtual video consultation with one of our doctors first. Your doctor will assess your skin, design a formula around what it needs and look after you afterwards. The same doctor stays with you, adjusts the treatment course by course and answers your questions by email.

There is no subscription and no auto-renewal. Each course is a single order you place yourself.

Licensed vs Compounded Clindamycin

There are three possible options for Clindamycin treatment. You can be prescribed a licensed product with Clindamycin alone (e.g. Dalacin T Topical Lotion or Zindaclin 1% gel) or a combined formula like Duac gels which pair Clindamycin with benzoyl peroxide at 3% or 5% or Treclin which pairs it with Tretinoin at 0.025%. There is also the option of compounded formulas, which are unlicensed treatments made individually for you by a specialist pharmacy. These can pair Clindamycin with any number of actives to address multiple concerns. Which option suits you depends on your skin, health and what skin concerns you are treating.

How Effective Is Clindamycin for Acne?

Clindamycin is licensed in the UK for acne vulgaris, and the evidence is strongest for what it does when used in combination with other acne-treating actives rather than alone. Here’s what the evidence and best use practices show:

• Inflammatory spots: Clindamycin reduces the papules and pustules of acne. It brings down C. acnes and the irritant free fatty acids it produces. This is the part of acne it treats directly.
• In combination: two of the five first-line acne treatments in the NICE guideline contain Clindamycin, and both pair it with a second active.
• On its own: NICE advises against treating acne with a topical antibiotic by itself, because of resistance. The licensed market reflects that, with six of the nine licensed topicals sold as fixed combinations.
• Blocked pores and post-acne marks: Clindamycin does neither. Comedones need something that shifts turnover and pigment needs a pigment active like Tretinoin.

It takes six to eight weeks on average to start seeing a noticeable change and a thorough assessment is needed at around three months of use. Clindamycin is prescribed in courses rather than indefinitely. NICE advises reviewing any antibiotic-containing acne treatment every three months. It also advises continuing beyond six months only in exceptional circumstances. Your doctor reviews your formula at the end of each course and decides then whether the Clindamycin stays in it.

What Strengths Does Clindamycin Come In?

Topical Clindamycin comes in one strength. Every licensed topical product in the UK contains 1%, whether it carries Clindamycin on its own or alongside a fixed partner. Our compounded formulas use the same 1%.

A higher strength is not available and may not help you. Clindamycin’s limit is not its concentration. It is resistance, and it treats one driver of acne out of several. What varies between formulas is not the Clindamycin. It is what sits alongside it, at what strength and in what base. A formula carrying Clindamycin with Tretinoin is a different treatment from one carrying Clindamycin with Azelaic acid, and your doctor sets those partner strengths around how reactive your skin is and what else is going on with it.

What Are the Side Effects of Clindamycin?

Most people tolerate Clindamycin well. The most common side effects are local and usually settle as your skin adjusts. They include:

• Dryness and skin irritation: where you apply it, most often during the first few weeks.
• Oiliness: an increase in surface oil, reported alongside the drying effects.
• Hives: raised itchy patches at the application site.

Clindamycin is absorbed through the skin in small amounts, and antibiotics taken into the body can disturb the bacteria in the gut. Folliculitis, contact dermatitis and abdominal pain have also been reported, although how often is not known. There are also some more severe but less common side effects such as:

• Diarrhoea or colitis: reported infrequently with topical Clindamycin. Stop and get medical advice the same day if it is significant or prolonged. This can begin up to several weeks after you finish the course.
• Stinging or pain in the eye: if the product gets near it, so keep it away from the eye area.
• Allergic reactions: rare, but stop and seek advice if you get swelling of the face or eyes, a rash beyond the application site or any difficulty breathing.

Regardless of severity, if you experience side effects when starting any treatment, always let your prescriber know straight away. If you’re a City Skin Clinic patient, just contact your dedicated doctor as all follow-up is free. For severe reactions like an allergy, it may be necessary to seek emergency medical assistance if you cannot immediately reach your provider.

Who Should Not Use Clindamycin?

Clindamycin suits most people with inflammatory acne. There are, however, a few situations that need extra care and some that rule it out:

• Broken or inflamed skin: wait until it has settled, and keep it away from the eyes, lips and nostrils.
• A history of inflammatory bowel disease or antibiotic-associated colitis: an outright contraindication on the licensed labels. Tell your doctor if you have Crohn’s disease or ulcerative colitis, or if you have had colitis after taking antibiotics.
• Allergy to Clindamycin, lincomycin or any ingredient in the formula: an outright reason not to use it.
• Pregnancy and breastfeeding: Clindamycin may be used in pregnancy and your doctor will decide whether it is right for you. The licensed label advises first trimester use only if clearly needed. Data from between 300 and 1,000 pregnancies found no increase in birth abnormalities in the second and third trimesters. Whether it passes into breast milk after use on the skin has not been studied. Acne often changes during pregnancy, so tell your doctor if you are pregnant or trying to conceive and they will build a formula around actives that are suitable at that time.
• Eczema and reactive skin: the licensed product is prescribed with caution in atopic individuals, so tell your doctor if that applies to you.
• Medicines that affect nerves and muscles: Clindamycin taken into the body can enhance the effect of neuromuscular blocking agents, so tell your doctor everything you take.
• Under 18: we treat adults only.