No comparative trials or meta-analyses compare efficacy of different combination therapies. A recent narrative review of clinical trials concluded that clindamycin plus benzoyl peroxide was more effective in reducing inflammatory lesions than monotherapy with either agent alone, and was similar in efficacy to benzoyl peroxide/erythromycin combination.8 Similarly, combination therapy with clindamycin and adapalene was superior to clindamycin alone in improving mild to moderate acne.9 Both 1% clindamycin and 2% erythromycin were comparable in reducing inflammatory and noninflammatory lesions for patients with moderate acne.10
Studies are ongoing for topical tetracycline, topical isotretinoin, and light and laser therapy in treatment of mild to moderate acne.
Recommendations from others
An expert review stated that treatment of acne should be individualized for best results.7 A report from the Global Alliance to Improve Outcomes in Acne states that topical retinoids are appropriate first-line therapy for all forms of acne and should be combined with topical antimicrobial therapy when inflammatory lesions are present.11