> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # Topical clindamycin — use and resistance > Clindamycin 1% is a lincosamide antibiotic used topically in inflammatory acne. Why it is never supplied alone, and what antibiotic stewardship means here. Clindamycin is a lincosamide antibiotic. Applied to the skin at low concentration it reduces *Cutibacterium acnes* in the follicle and has a direct anti-inflammatory effect on top of that. It is effective, and it carries a specific problem — resistance — which is why the way it is prescribed has changed considerably over the last two decades. ## What it is Active ingredient: **clindamycin 1%**, always in a fixed combination with [benzoyl peroxide](/library/medicines/benzoyl-peroxide) at **3% or 5%**, on the [acne](/library/conditions/acne) pathway. In the EU this combination is marketed under brand names including Duac. Topical clindamycin as a single agent is not prescribed here. ## How it works Clindamycin binds to the 50S subunit of the bacterial ribosome and blocks protein synthesis, which suppresses *C. acnes* in the pilosebaceous unit. Reducing the bacterial load reduces the inflammatory signalling that follows it. It also has an effect that is independent of its antibacterial action: it inhibits neutrophil chemotaxis and reduces the production of pro-inflammatory mediators. Part of the benefit in acne is therefore anti-inflammatory rather than antimicrobial, which is one reason it can help cases where the bacterial contribution is modest. ## Why it is never supplied alone **Topical antibiotic monotherapy in acne is no longer considered acceptable practice.** Resistant *C. acnes* emerged rapidly wherever topical antibiotics were used alone, and resistance is not confined to the target organism — it also develops in commensal staphylococci on the treated skin and on the skin of close contacts. Benzoyl peroxide suppresses that emergence, which is why the two are supplied as one product. The practical consequences of that rule are worth stating explicitly. The benzoyl peroxide component is not the optional half of the combination. Topical antibiotics for acne are used for defined periods rather than indefinitely. And a topical and an oral antibiotic of different classes are not used together, which is one of several reasons oral acne antibiotics sit outside what this service prescribes at all. ## What has been reported | Reported effect | Character | | ---------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Dryness, scaling and peeling | Common, driven mostly by the benzoyl peroxide component | | Burning, stinging or erythema | Common early; usually settles as tolerance develops | | Oily skin or a greasy feel | Reported, depending on the vehicle | | Contact dermatitis | Uncommon; an intensely itchy, spreading reaction is a reason to stop and seek advice | | Photosensitivity | Reported; daily broad-spectrum sun protection is part of the routine | | Gastrointestinal upset and colitis | Systemic absorption from a topical is low, but diarrhoea, abdominal cramping and — very rarely — antibiotic-associated colitis have been reported with topical clindamycin. Severe, persistent or bloody diarrhoea means stopping and seeking medical advice promptly | The acne questionnaire contains a dedicated question about diarrhoea. That is not a generic health enquiry — it is there because of the colitis association above, and because a history of antibiotic-associated colitis changes whether a clindamycin-containing product is appropriate at all. The benzoyl peroxide component bleaches fabric, towels, bedding and hair permanently. That effect and how to work around it are covered on the [benzoyl peroxide page](/library/medicines/benzoyl-peroxide). ## Realistic timelines Local irritation from the benzoyl peroxide component is the main early experience. Applying to fully dry skin and reducing frequency are the usual adjustments. Inflammatory papules and pustules typically reduce. Comedones respond less, because neither component is a strong comedolytic. The fair point of assessment. Because of the resistance question, a topical antibiotic is not a long-term maintenance agent. Maintenance usually moves to a non-antibiotic option, and the reviewing doctor decides what that looks like. ## Who it is not suitable for Anyone with known hypersensitivity to clindamycin, lincomycin, benzoyl peroxide or an excipient. Anyone with a history of regional enteritis, ulcerative colitis or antibiotic-associated colitis should expect that history to weigh heavily in the doctor's decision. It is not applied to broken, eczematous or sunburnt skin. Suitability in pregnancy and breastfeeding is a decision for the reviewing doctor, who needs to know first. ## How Hi-Doctor handles it The review is fully asynchronous — no video call, no telephone consultation. You complete the acne questionnaire, upload a photograph, and a registered doctor grades the case and decides which topical, if any, is appropriate. A prescription is never guaranteed; if one is not issued, the consultation fee is refunded in full. The medicine is dispensed and paid for at a pharmacy of your choosing, and the [pricing page](/essentials/pricing) covers what the consultation fee includes. ## Related reading * [Acne](/library/conditions/acne) * [Benzoyl peroxide](/library/medicines/benzoyl-peroxide) · [adapalene](/library/medicines/adapalene) · [azelaic acid](/library/medicines/azelaic-acid) * [Doxycycline](/library/medicines/doxycycline) — an oral tetracycline used elsewhere on this service, but **not** prescribed here for acne * [How to apply a prescription topical](/library/guides/how-to-apply-topicals) * [Side effects of dermatology topicals](/library/guides/side-effects-dermatology) * [Safety and eligibility](/essentials/safety) ## Start a consultation Answer the acne questionnaire, upload your photos, and a registered doctor reviews the case. They decide whether a topical treatment is appropriate and which one — declining is a normal outcome. See [what it costs](/essentials/pricing) and [how the review works](/essentials/how-it-works). This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.