Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics

Introduction

Topical antibiotics have been used widely as an effective treatment modality in treatment of acne for last 30 years.[1],[2] But emergence of resistant strains of Pacnes to commonly used antibiotics such as erythromycin and clindamycin is leading to therapeutic failure. Nicotinamide is a potent anti-inflammatory agent used in various dermatological disorders.[3] It was thought it would be helpful drug to treat acne by reducing the incidence of resistance.[4]

Materials and Methods

Seventy-five patients in the age group of 16-35 years were selected from our patients attending Dermatology Clinic in the Dermatology department of Bharati Hospital.

All patients had inflammatory acne vulgaris i.e. Grade II and III.

Parameters for grading were as follows:

Patients with only comedones, severe nodulocystic acne, pregnant women, lactating mothers, taking systemic medicines, having gastro-intestinal problems and any other major illness were excluded from study.

Written consent was taken from every patient. Detail history about onset, distribution of lesions, treatment taken and exacerbating factors was noted. Acne count, distribution and grading were done. Seventy-five patients were divided into 3 groups.

Group A: 28 fresh cases- Treated with 4% nicotinamide+ 1 % clindamycin

Group B: 29 fresh cases treated with 1% clindamycin.

Group C: 18 cases-Treated with 4% nicotinamide +1 % clindamycin (probably resistant cases who did not respond satisfactorily to topical antibiotics)

Follow up was done after 4 and 8 weeks and final results were drawn according to physicians′ global evaluation for inflammatory acne vulgaris.

Analysis was done for the 3 groups. X2 te: for significance was applied tt compare the results between Group A and Group B.

Results

Results are shown in tables I and II for Group A and Group B respectively. [Table - 3] show comparison between Group A and Group B. [Table - 4] shows the response in Group C. and Group B.

Discussion

In our study 50% patients from Group A showed moderate response and 17.5% showed excellent response and only 20% showed poor or no response. No side effects were seen except very mild burning sensation in few patients.

In Group B 44.82% of patients showed moderate response while 13.79% showed excellent response and 33.49% no response.

Thus there is no difference in the efficacy of both plain clindamycin and its combination with nicotinamide. Applying X2 test resulted in value of p< 0.05, hence the null hypothesis was accepted concluding there is no difference in the efficacy of both the agents.

This means that combination of 4% nicotinamide and 1 % clindamycin is effective in fresh cases on acne vulgaris but its efficacy is comparable to plain 1 % clindamycin and of no added advantage.

In group C, 55.54% patients showed poor or no response, 27.7% moderate response and only 16.6% excellent response. So it again shows that addition of nicotinamide to clindamycin is of no great value in treating acne resistant to topical antibiotics.