Can you use adapalene with clindamycin?
The chemistry
Adapalene normalises follicle shedding and reduces comedones (Irby 2008). Clindamycin is a topical antibiotic that reduces Cutibacterium acnes and inflammation. Guidelines recommend combining a retinoid with an antimicrobial, but warn that topical antibiotics alone breed resistance, so benzoyl peroxide should be added (Zaenglein 2016, Reynolds 2024). A triple combination gel of clindamycin, benzoyl peroxide and adapalene has shown good results in trials (Eichenfield 2023). The two ingredients act on different stages of acne: adapalene stops new clogged pores forming, while clindamycin calms the red, inflamed papules that grow from them. Studies of fixed combinations of clindamycin with benzoyl peroxide show good efficacy and tolerability (Schlessinger 2007), and combination therapy is generally better than single agents (Zeichner 2012).
Guideline
Retinoid plus antimicrobial is standard.
Resistance
Add benzoyl peroxide with clindamycin.
Prescription
Clindamycin requires a prescription.
Common mistakes
Clindamycin should not be used for years; dermatologists typically limit it to about three months, then continue with adapalene and benzoyl peroxide. Adapalene can cause dryness and stinging in the first month, the so-called retinoid reaction, and acne can seem to worsen briefly. Start adapalene every other night and use a non-comedogenic moisturizer. Clindamycin gels and lotions are usually well tolerated, so most irritation in this routine comes from adapalene or benzoyl peroxide. If your prescription is a combination product, follow the label instead of layering separate products. Adapalene 0.1 percent is available over the counter in many countries, while clindamycin is prescription-only. If acne is nodular, scarring or not responding after three months, oral treatments may be appropriate, so revisit your doctor rather than adding more topicals. There is now a single gel containing all three: clindamycin 1.2%, adapalene 0.15% and benzoyl peroxide 3.1%, sold as Cabtreo. In two phase 3 trials it improved moderate to severe acne more than its vehicle over 12 weeks (Stein Gold 2023), and in earlier studies it was well tolerated with low sensitisation (Draelos 2023). The label directs once-daily use. It is prescription-only.
Your routine
Morning
- Cleanser
- Clindamycin with benzoyl peroxide
- Sunscreen SPF 30+
Evening
- Cleanser
- Adapalene
- Moisturizer
Go slower if
Avoid adapalene in pregnancy. Report severe diarrhoea to a doctor (rare with topical clindamycin).
Evidence strength
Strong.
FAQ
Why not clindamycin alone?
Resistance develops.
How long until I see improvement with this routine?
Most people see a meaningful change in 8 to 12 weeks. Inflamed spots usually improve first, blackheads and whiteheads more slowly.
Can I use the clindamycin only on spots?
Antibiotic gels are generally applied to the whole acne-prone area, not dabbed on spots, since they prevent new lesions as well as treating existing ones. Follow your prescriber's instructions.
Is there one product with adapalene, clindamycin and benzoyl peroxide?
Yes, a prescription triple-combination gel (Cabtreo), applied once a day.
Related combinations
- RetinolNo, not together
- Vitamin CYes, with timing
- NiacinamideYes
- TretinoinNo, not together
- Salicylic AcidYes, with timing
- Hyaluronic AcidYes
- Glycolic AcidYes, with timing
- Benzoyl PeroxideYes
Sources
- Irby CE, et al. A review of adapalene in the treatment of acne vulgaris. J Adolesc Health. 2008;43(5):421-4.
- Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.
- Reynolds RV, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30.
- Eichenfield LF, Stein Gold L, Kircik LH, et al. Triple-combination clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel for moderate-to-severe acne in children and adolescents: randomized phase 2 study. Pediatr Dermatol. 2023;40(3):452-459.
- Schlessinger J, Menter A, Gold M, et al. Clinical safety and efficacy studies of a novel formulation combining 1.2% clindamycin phosphate and 0.025% tretinoin for the treatment of acne vulgaris. J Drugs Dermatol. 2007;6(6):607-615.
- Zeichner JA. Optimizing topical combination therapy for the treatment of acne vulgaris. J Drugs Dermatol. 2012;11(3):313-317.
- Stein Gold L, et al. Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel for moderate-to-severe acne: efficacy and safety results from two randomized phase 3 trials. J Am Acad Dermatol. 2023;89(5):927-935.
- Draelos ZD, et al. Dermal sensitization, safety, and tolerability of triple-combination clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel from three clinical trials. J Dermatolog Treat. 2023;34(1):2220446.
- Cabtreo (clindamycin phosphate, adapalene and benzoyl peroxide) topical gel. Prescribing information. DailyMed, US National Library of Medicine.