Tools for Practice

#288 Clearing up the Evidence for Topical Acne Combination Products

How effective are topical combination products for moderate facial acne?

For patients using combination products, including benzoyl peroxide/adapalene and benzoyl peroxide/clindamycin, about 40-50% will perceive complete or near complete improvement in their acne, compared to 30-40% using individual products, and 20-30% using vehicle. No direct head-to-head trials with patient reported outcomes exist between combination products. Cost may influence product choice.

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Focused on randomized, controlled trials (RCTs) with similar patient reported outcomes. Patients had mostly moderate facial acne. Outcomes meta-analyzed by TFP authors. Benzoyl peroxide/adapalene (Tactupump®):
  • 2 RCTs,1,2 2187 patients; benzoyl peroxide 2.5%/adapalene 0.1% daily versus individual components or vehicle. At 12 weeks:
    • Marked or complete improvement:
      • Combination 48% versus adapalene 42%, benzoyl peroxide 37%, vehicle 27%. Numbers needed to treat (NNT): 17, 10, 5, respectively.
  • Local adverse events (most commonly stinging, erythema, dryness, scaling):
    • Combination 27% versus adapalene 19%, benzoyl peroxide 11%, vehicle 8%. Numbers needed to harm (NNH)=13, 7, 6, respectively.
    • Mostly transient and worse in first two weeks.
Benzoyl peroxide/clindamycin (Clindoxyl®, Benzaclin®):
  • 2 RCTs,3,4 3311 patients; benzoyl peroxide (varying concentrations)/clindamycin 1.2% daily versus individual components or vehicle. At 12 weeks:
    • Clear or almost clear skin:
      • Combination ~38%, clindamycin 30%, benzoyl peroxide 30%, vehicle 17%. NNTs 12, 12, 5, respectively.
    • Adverse events: No difference.
  • No trials clearly publicly funded.
  • Topical retinoids and benzoyl peroxide (alone or combined with adapalene or clindamycin) are first line for mild papulopustular facial acne.5
    • Oral contraceptives, antibiotics, and isotretinoin are recommended for failure of above or severe acne.5
  • Clindamycin/tretinoin (Biacna®): no RCTs with patient reported outcomes found.
  • Different concentrations of benzoyl peroxide have similar effectiveness/tolerability.6
  • Estimated costs for 90 days (once daily application):7,8
    • Benzoyl peroxide 5% (Benzagel®): $35
    • Tretinoin 0.025% cream (Stieva-A Cream®): $50
    • Benzoyl peroxide 5%/clindamycin 1% (Benzaclin®, Clindoxyl®): $100-120
    • Benzoyl peroxide 2.5%/adapalene 0.1% (Tactupump®): $220
      • Adapalene 0.1% cream, 0.3% gel (Differin®): $300-340

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  • Michael R Kolber MD CCFP MSc
  • Paul Fritsch MD CCFP
  • Stacy Jardine BScPharm

1. Gollnick HP, Draelos Z, Glenn MJ, et al. Brit J Derm. 2009; 161(5):1180-9.

2. Thiboutot DM, Weiss J, Bucko A, et al. J Am Acad Derm. 2007; 57(5):791-9.

3. Pariser DM, Rich P, Cook-Bolden FE, et al. J Drugs Derm. 2014; 13(9):611-7.

4. Thiboutot D, Zaenglein A, Weiss J, et al. J Am Acad Derm. 2008; 59(5):792-800.

5. Asai Y, Baibergenova A, Dutil M, et al. CMAJ. 2016; 188(2):118-26.

6. Yang Z, Zhang Y, Mosler EL, et al. Cochrane Database Syst Rev. 2020; 3(3):CD011154.

7. Interactive Drug Benefit List [website]. Edmonton, AB: Government of Alberta; 2020. Available from: Accessed 2020 Nov 12.

8. Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) [website]. Edmonton, AB: Government of Alberta; Effective November 13, 2020. Available from: Accessed on 2020 Nov 12.

Authors do not have any conflicts of interest to declare.