Tretinoin with clindamycin

How it works

Tretinoin normalises follicular keratinisation to prevent and clear comedones, while clindamycin is a lincosamide antibiotic that suppresses Cutibacterium acnes and reduces inflammation; the retinoid component also helps limit antibiotic-resistance selection.

Prescribing in practice

• As it contains a retinoid, it is contraindicated in pregnancy and women of child-bearing potential should use effective contraception.
• To limit antimicrobial resistance, topical antibiotic use should be time-limited and ideally combined with benzoyl peroxide rather than used as antibiotic monotherapy; clindamycin carries a rare risk of antibiotic-associated colitis.
• Local irritation, dryness, peeling and photosensitivity are common, so sun protection is advised and use on broken or eczematous skin avoided.

Monitoring

No laboratory monitoring is needed; review acne response and skin tolerability and limit the duration of the antibiotic component.

Counselling the patient

• Apply a thin film to the whole affected area at night, not just individual spots, and use sun protection by day.
• Some dryness and irritation is expected initially; allow several weeks for improvement.
• Do not use in pregnancy, and report any severe or persistent diarrhoea.

Evidence & guidelines

NICE recommends fixed topical retinoid-plus-antibiotic combinations as a first-line option for acne, with antibiotic courses kept short to reduce resistance.