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Erythromycin/Benzoyl Peroxide Gel Significantly Improves Acne

A combination gel of erythromycin and benzoyl peroxide may provide more benefit to patients with moderate acne vulgaris than does a combination of tretinoin and erythromycin, say researchers.

Dermatology specialists in Toronto, Ontario, Canada, reached this conclusion after running a multi-centre, randomised, double- blind, parallel group study of these two topical gels.

The specialists pointed out that combination treatments for acne vulgaris such as these reduced both bacterial growth, which contributed to the inflammatory lesions typical of adolescent acne, and the epidermal cell compaction which might form the characteristic non-inflammatory comedone.

Both gels contained erythromycin to reduce the growth of Propionibacterium acnes in skin. Benzoyl peroxide had antibiotic activity as well as anti-comedogenic properties. Tretinoin might increase the turnover of epidermal cells and loosen cells compacted to form comedones.

The specialists speculated that a combination of the two antibiotics might reduce the development of resistance while the combination of tretinoin and erythromycin might have an antibiotic effect as well as acting on differentiation.

They compared the effectiveness of 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/ erythromycin 4%, each applied twice daily to patients with moderate acne.

Physician and patient ratings of severity of acne symptoms were performed at baseline and at 2, 4, 8 and 12 weeks.

At baseline, the two treatment groups had similar disease severity; at week 12, they showed similar reductions of papules, pustules and comedones.

Global physician rating of improvement was significantly higher in patients given the erythromycin/benzoyl peroxide gel. Global patient ratings in the two treatment groups did not significantly differ.

When physician ratings and patient ratings were aggregated by adding up individual symptom severity ratings, both physician- rated and patient-rated severity of acne symptoms fell significantly more with erythromycin/benzoyl peroxide. This was evident from as early as the second week.

Erythromycin/benzoyl peroxide reduced erythema and scaling, as assessed by the study physician, significantly more than tretinoin/ erythromycin.
Patients judged erythromycin/benzoyl peroxide to have a significantly greater effect on redness, dryness, oiliness and burning.
Journal of Cutaneous Medicine and Surgery 2003 Apr;DOI: 10.1007/s10227-002-2101-2.

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