TOPICAL NICOTINAMIDE COMPARED WITH CLINDAMYCIN GEL IN THE TREATMENT OF INFLAMMATORY ACNE-VULGARIS

Background. Systemic and topical antimicrobials are effective in the t reatment of inflammatory acne vulgaris; however, widespread use of the se agents is becoming increasingly associated with the emergence of re sistant pathogens raising concerns about microorganism resistance and highlighting the need for alternative nonantimicrobial agents for the treatment of acne. Nicotinamide gel provides potent antiinflammatory a ctivity without the risk of inducing bacterial resistance. Methods. In our double-blind investigation, the safety and efficacy of topically applied 4% nicotinamide gel was compared to 1% clindamycin gel for the treatment of moderate inflammatory acne vulgaris. Seventy-six patient s were randomly assigned to apply either 4% nicotinamide gel (n = 38) or 1% clindamycin gel (n = 38) twice daily for 8 weeks. Efficacy was e valuated at 4 and 8 weeks using a Physician's Global Evaluation, Acne Lesion Counts, and an Acne Severity Rating. Results. After 8 weeks, bo th treatments produced comparable (P = 0.19) beneficial results in the Physician's Global Evaluation of Inflammatory Acne; 82% of the patien ts treated with nicotinamide gel and 68% treated with clindamycin gel were improved. Both treatments produced statistically similar reductio ns in acne lesions (papules/pustules; -60%, nicotinamide vs. -43%, cli ndamycin, P = 0.168), and acne severity (-52% nicotinamide group vs. - 38% clindamycin group, P = 0.161). Conclusions. These data demonstrate that 4% nicotinamide gel is of comparable efficacy to 1% clindamycin gel in the treatment of acne vulgaris. Because topical clindamycin, li ke other antimicrobials, is associated with emergence of resistant mic roorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.