Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease Original paper

What Was Reviewed?

This review paper focuses on the scientific rationale and clinical basis for using clindamycin in treating dermatologic diseases. It details clindamycin’s antibacterial and anti-inflammatory roles, particularly its established use in acne vulgaris, folliculitis, rosacea, hidradenitis suppurativa (HS), and staphylococcal infections. The authors also explore its mechanism of action, highlighting how clindamycin inhibits bacterial protein synthesis by targeting the 50S subunit of the bacterial ribosome. The review contrasts clindamycin’s dermatological indications with those of tetracyclines. It checked trends in antibiotic resistance, offering a robust understanding of how clindamycin has maintained relevance in dermatology despite rising resistance concerns​.

Who Was Reviewed?

The review primarily covers patients affected by dermatologic conditions where clindamycin is indicated, including acne vulgaris sufferers, individuals with bacterial folliculitis, rosacea, HS, and staphylococcal infections. The paper contextualizes microbial involvement, particularly the role of Cutibacterium acnes (formerly Propionibacterium acnes), and outlines the bacterium’s phylotypes and pathogenicity. It also reviews bacterial species relevant to resistance patterns, such as Staphylococcus aureus and Staphylococcus epidermidis, reflecting the broader impact of clindamycin on the skin microbiome​.

What Were the Most Important Findings?

Key findings center on clindamycin’s dual action: its efficacy in suppressing C. acnes growth and its notable anti-inflammatory effects. The review emphasizes that specific ribotypes of C. acnes are more virulent, contributing to inflammation and biofilm formation in acne. Topical clindamycin, often combined with benzoyl peroxide or retinoids, proves highly effective across various acne severities, with additional success noted in folliculitis, rosacea, and HS. Resistance trends are a major concern, with C. acnes resistance to clindamycin and macrolides reported in up to 90% of cases in some regions, driven by gene transfers. The review underscores the need for stewardship to mitigate resistance while recognizing clindamycin’s continued clinical value due to its safety, effectiveness, and versatility​.

What Are the Greatest Implications of This Review?

The review highlights the importance of balancing effective clindamycin use with antibiotic stewardship to limit resistance. For clinicians, the detailed exploration of C. acnes pathogenicity, clindamycin’s mechanism of action, and emerging resistance informs better treatment planning. The paper suggests that, despite high resistance rates, topical clindamycin remains a core treatment, particularly when combined with other agents to reduce monotherapy risks. Additionally, the work calls attention to the delicate balance of the skin microbiome and the need for ongoing surveillance and innovation in dermatologic therapies​.