Clindamycin phosphate, an alternative solution in the treatment of rosacea acne?

Clindamycin phosphate is a antibiotic belonging to the lincosamide class. Frequently used to treat acne, it is prescribed in cases of papulopustular rosacea, a specific form of rosacea that is sometimes confused with acne due to similar symptoms. Indeed, in addition to the characteristic redness of rosacea, papulopustular rosacea leads to the emergence of papules, and in some cases, pustules. This form can significantly impact the confidence and self-esteem of the affected patient.

Papulopustular rosacea is typically treated with antibiotics, notably clindamycin phosphate. Clindamycin acts on bacteria at the level of the ribosome assembly mechanisms as well as the translation process. Clindamycin directly targets the peptidyl-transferase loop located on the 50S ribosomal subunit, corresponding to the site of peptide bond formation during the final stages of bacterial protein synthesis. Since bacteria cannot survive without their proteins, the interference caused by clindamycin leads to their destruction.

It is noteworthy that clindamycin phosphate is inactive in vitro. However, when applied to the skin, it is rapidly transformed by swift hydrolysis into clindamycin, a compound that, as described above, is capable of exerting antibacterial activity. Furthermore, clindamycin has interesting anti-inflammatory properties for reducing inflammatory lesions found on skin suffering from papulopustular rosacea. It works by inhibiting the release of the transcription factor NF-κB and the enzyme COX-2, which is involved in the production of inflammatory prostaglandins.

The effects of clindamycin were evaluated in a study conducted by DEWITT and his team. For this purpose, 43 patients suffering from rosacea were recruited. Two groups were formed. Volunteers in the first group applied a clindamycin-based gel twice a day and took 250 mg of tetracycline four times a day. Those in the second group also applied the gel but received placebo capsules. After three months, the scientists observed a general decrease in erythema, an average reduction of 50% in papules, and a nearly 75% decrease in pustules among all patients, without noting any significant difference between the two groups.

Generally well-tolerated, clindamycin phosphate is an appealing solution for combating rosacea acne. To enhance its effectiveness, it is often combined with topical retinoids, such as the tretinoin.

Although clindamycin phosphate is generally very well tolerated, it can sometimes cause undesirable side effects. It has been observed that this medication can, in rare cases, lead to headaches, redness, skin dryness, itching, or local irritation. If these effects persist or worsen, it is important todiscuss it with your doctor, so that they can adjust the treatment. It should be noted that it is advised against applying a gel containing clindamycin phosphate near the eyes, mouth, or mucous membranes. In case of accidental contact, an immediate rinse with cold water reduces the risk of irritation.

It is also important to note that clindamycin phosphate is generally not recommended for pregnant or breastfeeding women. Indeed, this substance is suspected of being able to enter the bloodstream and reach breast milk. Clindamycin phosphate could then cause disturbances in the infant's microbiota. Moreover, this medication is also contraindicated for individuals with hypersensitivity to lincomycin, another antibiotic from the lincosamide family. Finally, in very rare cases, clindamycin has been associated with pseudomembranous colitis, following inflammation of the colon. Special attention should therefore be paid in case of diarrhea occurring during treatment with clindamycin phosphate.

• DEWITT S. & al. Treatement of rosacea : Topical Clindamycine versus oral tetracycline. International Journal of Dermatology (1993).

• FORBES B. & al. Activation of clindamycin phosphate by human skin. Journal of Applied Microbiology (2001).

• CHAUDHRY M. & al. Rosacea and its management: an overview. Journal of the European Academy of Dermatology & Venereology (2005).

• VIDAL. Substance Active Clindamycine. (2013).