Patients with mild to moderate inflammatory acne and, who have not responded to non antibacterial topical preparations (e.g. benzoyl peroxide) can be given the antibacterial topical acne preparations. Although some controversy exists that the latter are no more effective than the non-inflammatory topical preparations, they can still be offered to the patient if he/she cannot tolerate oral antibiotic therapy or just does not want to take oral therapy.



Topical preparations of erythromycin and clindamycin are effective for inflammatory acne. Preparations containing tetracyclines have shown some efficacy too but as much as the erythromycin and clindamycin preparations.

As you may already know, the main causative organism responsible in the formation of acne is called Propionibacterium acnes. Unfortunately with the increase in antimicrobial treatments (topical and oral) , this organism has been able to gain resistance to certain antimicrobial agents and therefore, care must be taken in prescribing these agents.

Available topical agents

1.Benzamycin (Scwarz): this comes in a gel pack which needs to be reconstituted. It contains benzoyl peroxide and erythromycin in an alcoholic base. This should be applied twice daily; very fair skinned people should try to apply this once daily, preferably at night.

2.Dalacin T (Pharmacia): this is a topical solution containing clindamycin phosphate in aqueous alcoholic base, which can be applied twice daily. There is also a lotion form (cindamycin in an aqueous base) which can also be applied twice daily.

3.Stiemycin (Stiefel): this is a solution of erythromycin and an alcoholic base which is applied twice daily (morning and night after cleansing the skin).

4.Topicycline (Shire): this is a solution (for reconstitution with an alcoholic base) of tetracycline hydrochloride and 4-epitetracycline hydrochloride. This solution can also be applied twice daily to affected areas after skin cleansing.

5.Zindalacin (Strakan): gel based preparation of clindamycin. This should be applied once daily (preferably at night after skin cleansing).

6.Zineryt (Yamanouchi): Topical solution. Comes with powder for reconstitution of erythromycin, zinc acetate which needs to be made into a solution with an alcoholic ethanol base (provided in the pack). This solution must be applied twice daily after skin cleansing.

It is worthy of noting that treatments should always be completed except for when side effects are experienced; this increases efficacy of the agent and also decreases the development of bacterial resistance. Treatments should be continued for at least 6 months; this is a recommendation based on clinical literature.

Side effects

The main side effects of topic antimicrobial preparations for acne management include mild skin irritation and on rare occasions cause sensitisation.

Reports of rashes and severe skin itching have been reported but, this is a rare finding and seldom occurs.

Efficacy

As mentioned above, these agents, in some cases are no more efficient than non antibacterial topical preparations but many patients feel more confident in using this form of therapy as opposed to oral antibiotic therapy. Results may take longer for the topical preparations but in some patients, results can be seen from 3 months into treatment.