Oral Isotretinoin Vs. Clindamycin
When acne is particularly severe, resulting in large cysts that form deep under the skin, your dermatologist's assistance is required to find an adequate way to resolve this painful, disfiguring and potentially scarring skin condition. However, even milder cases of acne may not respond to over-the-counter treatments. Two prescription medications for acne are isotretinoin, which is taken in a pill form, and clindamycin, which is typically prescribed as a topical treatment. However, while both of these medications are used to resolve acne, they do so in very different ways.
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Oral Isotretinoin vs. Clindamycin
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Both of these medications have some similarities in that they resolve acne by fighting the various factors that cause acne: bacteria, excess oil production, inflammation and clogged pores due to the sloughing of dead skin cells. However, clindamycin is a topical bacterial treatment that works by reducing the bacteria (Propionibacterium acnes) that causes acne to form, thereby reducing inflammation caused by acne. Oral isotretinoin is a onetime treatment regimen that resolves all of the factors that cause acne mentioned above.
About Clindamycin
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According to the American Academy of Dermatology, topical clindamycin has been in use for many years and has yielded many success stories. Clindamycin reduces the number of P. acnes bacteria, decreases inflammation and is considered safe to use in most patients. Some side-effects that may occur are dryness of the skin or irritation. Clindamycin can be prescribed in its oral form. However, because it can cause diarrhea, doctors most often prescribe other antibiotics for acne, such as erythromycin, tetracycline or a tetracycline synthetic derivative. Because clindamycin is commonly prescribed as a topical treatment, it requires ongoing use to resolve acne.
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About Oral Isotretinoin
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Oral isotretinoin is a vitamin A derivative that's taken for 16 to 20 weeks, after which no additional treatment is needed in the majority of patients. Isotretinoin is a very strong medication that can cause many complications, and because it can harm a developing fetus, women in their childbearing years are required to use two forms of birth control and undergo routine pregnancy tests during treatment. Oral isotretinion may not be appropriate for everyone, particularly those with certain medical conditions. For example, it can cause high sugar levels in diabetic patients. Unlike milder topical treatments, isotretinoin may have more pronounced common side-effects during use, including dry eyes, nose and skin; thinning hair; joint pain; and nosebleeds.
Acne Severity
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Prescription medications are recommended based on the severity of your acne. Oral isotretinoin is most commonly used for severe forms of acne that are unresponsive to any oral antibiotics or topical treatments. However, topical antimicrobials such as clindamycin may be more appropriate for those with mild-to-moderately-severe acne, according to the AAD.
Deciding on Your Treatment
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According to the AAD, the decision to use oral isotretinoin should be made jointly between patient and doctor, as use of this medication can cause severe side-effects (see Resources). Topical clindamycin requires less ongoing monitoring, although it's important to note that even the use of antimicrobials can cause patients to build up a resistance to the bacteria that causes acne. Ultimately, the decision to use oral isotretinoin, clindamycin or any other type of prescription acne medication is best made after a thorough discussion with your dermatologist about the pros and cons of the various treatments. You should also discuss your long-term expectations.
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