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Treatment for acne includes the use of retinoids, antibiotics, azelaic acid, salicylic acid, dapsone, isotretinoin, and other off label medications. Combination medicines are also prescribed for treatment of acne when other over the counter formulations have not delivered the desired outcomes. Following subsections offer a detailed look at one commonly used prescription medication, including the possible side effects of benzoyl peroxide and clindamycin. This is intended to help users understand more about the topical application, and prevent any possible undesirable outcomes from its use.

Overview of benzoyl peroxide and clindamycin topical

The topical application comprises benzoyl peroxide, an antibacterial agent; and clindamycin, an antibiotic. Each has potent properties and the combined effects of the two helps in managing acne effectively. The combined effects kill the acne causing bacteria, and additionally cleanse the pores on the skin, preventing the formation of acne. Before we take a closer look at each, including the mechanism of action, to give better insights about the impact on the condition, it is necessary to know more about acne.

What causes acne?

A relatively common skin condition that afflicts teenagers, with most teenagers typically being free of acne after the age of twenty. The condition occurs when hair follicles are clogged, and when the oil secreted naturally in the skin to prevent drying, ends up clogging the pores. Dead skin cells are also known to plug the skin pores along with the oil. The combination of the sebum and skin cells accumulating is the outbreak of lesions, that may typically be seen on the face. In a relatively smaller section of individuals, the outbreak of lesions may also occur on the back and the chest.

When sebum is trapped and prevented from reaching the surface of the skin, it becomes a medium for the hair and dead skin cells to clog the pores. It also promotes the growth of bacteria in the clogged pores and this results in inflammation, apart reddish appearance, pain and generation of heat. This bacteria typically lives on the skin and is harmless when on the skin. However, when it grows inside the pores, it triggers undesirable effects. Additionally, when the walls of the affected follicle break, lesions and pimples are formed, creating the visible effects.

What are the different types of Acne?

There are typically six different types of acne, and the common term for the clogged pores are comedones. The different types include:

#1 Whiteheads – This refers to the pores and hair follicles that cause the formation of a white colored bump on the surface of the skin. In whiteheads, the hair follicles do not break out of the skin, but remain trapped beneath the skin.

#2 Blackheads – This refers to the hair follicles that break out of the skin. The coloration of the bumps is due to the effect of the air on the accumulated sebum. Washing the blackheads will not take away the color.

#3 Papules– This refers to relatively small skin bumps, that have a distinct pink color. Papules are generally tender, when touched and are painful.

#4 Pimples– Also known as pustules, this refers to lesions that have a distinct red color at the bottom and are either capped by white or yellow tips with pus. These are essentially a different type of papules with pus.

#5 Nodules– This refers to lesions that are relatively large in size, and harder than others. These lesions are typically deeper in the skin and require more extensive treatment options.

#6 Severe cystic acne- Also known as nodular acne, this is also another category of lesions that are lodged deep in the skin, and are painful to the touch. These lesions are mostly filled with pus and also require extensive treatment.

What causes acne in teenagers?

Various reasons are attributed to the outbreak of acne on the skin. This includes excessive production of sebum in the pores of the skin. Similarly, when the accumulation of dead skin cells is more, there is every likelihood of acne breakout. The growth of bacteria in the skin is also known to be a cause for acne. Certain individuals are more prone to the condition due to certain specific reasons. For instance, teenagers are more prone to the condition due to age factors. Similarly, individuals with a family history of acne are more likely to have the condition. Other causes include certain medications – this includes formulations with corticosteroids and lithium.

Finally, hormones are also known to have a role in acne and individuals with increased levels of androgen are likely to have acne. Androgen is essentially male sex hormones, and both boys and girls in puberty may end up with increased levels of this hormone. Consequently, there could be an enlargement of the glands that secrete sebum, and this could result in more production of sebum. Pregnant women are also prone to acne, mainly because of the hormonal changes that occur during pregnancy, and this results in the outbreak of the lesions.

Constituents of the combination medication

Benzoyl peroxide in the topical application is essentially an anti-inflammatory agent, and is also prescribed as single topical application. It is also known to have a drying effect, and this helps in cleansing the excessive oil secreted, and the dirt that collects in the pores.  Benzoyl peroxide promotes the rate at which skin cells form, and this in turn has an effect on the speed with which skin cells peel. As a result of this, the comedones break down, offering desired outcomes in acne management.

Clindamycin in the topical application is an antibiotic that has an effect on the bacteria in the skin. Known as a lincosamide antibiotic, it is effective in treating infections attributed to different types of bacteria including anaerobic, streptococcal, and pneumococcal. Clindamycin is known to have a narrow spectrum of activity, and inhibits bacterial proteins from their binding action, and is known to have effects on the acne causing bacteria Propionibacterium acnes.

Commonly reported side effects of benzoyl peroxide and clindamycin

All medications are likely to trigger undesirable outcomes and this extends to topical applications. Effects may be mild in nature or could be serious in nature. The mild category of effects may resolve naturally and may not require any form of medical intervention for most individuals. These are relatively frequently occurring in nature. The serious effects are known to be more frequently occurring and may require some form of medical attention. This could, if left untreated, progressively develop into more serious conditions. It is necessary to add here, that all individuals treated with medications or applications may not necessarily end up with side effects. Some are known to be fully free from all effects.

The type and intensity of effects are determined by various factors, such as the age of the individual, the gender, the condition being treated, the dosage, the schedule and the presence of other conditions. Here is a quick compilation of some of the commonly known effects of this topical application. All the effects are not listed out here, with only the common categories listed out to act as a reference.

Frequently occurring effects

Diarrhea is a commonly occurring condition in certain individuals, and in some rare instances, it could also be severe in nature. Individuals with diarrhea and on medications, are advised to use the application only after treatment for diarrhea has concluded, as the combination may aggravate diarrhea.  Other effects that may be frequently experienced include increased sensitivity to light. Individuals who apply the combination drug are to take suitable protective/preventive measures apply by applying a sunscreen before heading outdoors. Suntanning is to be fully avoided, when on acne treatment.

Other effects include possible drying skin, while many are known to experience some kind of undesirable effect on the area of application. This could be burning sensations, or outbreak of rashes and soreness. Itching sensations are also relatively common for some users. Discernible effects include peeling of the skin, while some are known to appear sunburned. The skin may be unusually warm to the touch after the application. These effects are not a cause for concern and can be easily resolved.

Drug interactions of the topical application

In addition to the possible undesirable outcomes of medications, there is also the possibility of drug interactions. This refers to the effects that occur when two or more drugs or medications in different forms are used on the patient. This could be treatment for either the same condition or for different conditions. Effects are generally of three types and suitable remedial or preventive measures are recommended accordingly. The first category is an increase in the potency of one or both the drugs, due to the mechanism of action. The second type is a reduction in the effectiveness of either or both of the two medications. The third type of effect is a possible increase in the side effects of either or both the medications, compared with the usual effects that are experienced when taken alone.

Protocols for treatment include identification of medications that cause interactions, and this is followed by temporary suspension of either of the two drugs. This is determined by checking the importance of both. In the event that both the medications are equally important cannot be suspended or discontinued, doctors, alter the dosage and modify the schedule of intake. This helps in mitigating or reducing the possible outcomes of the interaction. Here is a short compilation of some of the medications that may interact with the combination topical application. This is not an exhaustive list, but a compilation of categories.

Erythromycin may cause undesirable effects and is generally not recommended to be taken along with the combination treatment for acne. Other drugs that could interact include neuromuscular blocking drugs used for skeletal muscle relaxation during anesthesia. Interactions are not limited to medications alone, but may also be caused due to certain food products, beverages and tobacco products. The use of other cosmetic applications on the affected part may have other effects. For instance, applications or medications that are used for promoting skin rejuvenation of skin peeling are to be avoided fully, as this could cause effects. Before the use of any skin care product, on the affected part, it is necessary to consult the treating dermatologist.