Clindamycin for Rosacea
Clindamycin is not a standard FDA-approved treatment for rosacea, but topical clindamycin combined with benzoyl peroxide has demonstrated efficacy in clinical trials for moderate to severe papulopustular rosacea and may be considered as an off-label option when FDA-approved therapies are unsuitable.
Current FDA-Approved Treatments for Rosacea
The established FDA-approved topical agents for rosacea include metronidazole, azelaic acid, ivermectin cream, minocycline foam, and encapsulated benzoyl peroxide—notably, clindamycin monotherapy is not among these approved options 1. The 2020 global Rosacea Consensus (ROSCO) panel endorses phenotype-based treatment tailored to the specific signs and symptoms present, with topical therapy as the preferred initial approach 1.
Evidence for Clindamycin Use in Rosacea
Clindamycin/Benzoyl Peroxide Combination
A 12-week randomized, double-blind, vehicle-controlled trial demonstrated that once-daily topical application of 5% benzoyl peroxide/1% clindamycin gel achieved a 71.3% reduction in papules and pustules compared to 19.3% with vehicle (P = 0.0056), with significant improvement evident by week 3 2.
This combination also significantly improved overall rosacea severity, Physician Global Assessment, and Patient Global Assessment scores compared to vehicle, with good tolerability (application site reactions in only 14.8% of patients) 2.
The formulation reduced severity scores for erythema, papules/pustules, and flushing/blushing more effectively than vehicle 2.
Clindamycin/Tretinoin Combination
A pilot study of clindamycin phosphate 1.2%/tretinoin 0.025% gel showed no significant reduction in papule/pustule counts after 12 weeks compared to placebo (P=0.10) 3.
However, this combination demonstrated nearly significant improvement in telangiectasia (P=0.06) and erythematotelangiectatic rosacea subtype (P=0.05), suggesting potential benefit for the vascular component rather than inflammatory lesions 3.
An open-label trial showed dramatic decrease in pustules and papules without significant inflammation, though no improvement in facial redness was achieved 4.
Recent Formulation Development
- A 2025 study developed an emulgel containing both metronidazole and clindamycin, demonstrating better antimicrobial activity than formulations with either antibiotic separately, with no antagonism between the two agents and suitable anti-inflammatory effects 5.
Clinical Context and Limitations
Important caveat: While clindamycin shows promise in combination formulations for rosacea, it is primarily indicated and FDA-approved for acne vulgaris, not rosacea 1, 6. The American Academy of Dermatology recommends clindamycin for acne treatment, particularly in combination with benzoyl peroxide 6.
When to Consider Clindamycin for Rosacea
For papulopustular rosacea when FDA-approved options (metronidazole, azelaic acid, ivermectin, minocycline foam) have failed or are contraindicated 1, 2.
Use clindamycin combined with benzoyl peroxide rather than clindamycin monotherapy, as the combination has demonstrated superior efficacy 2.
Avoid in patients with history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis 1.
Practical Application
Apply once daily to affected areas 2.
Monitor for application site reactions including dermatitis, erythema, dryness, and peeling 1, 6.
Minimize sun exposure after application due to photosensitivity potential 6.
Antibiotic Resistance Considerations
Clindamycin resistance is an emerging concern in dermatology, and its use should be targeted and combined with benzoyl peroxide to reduce resistance development 7. The combination approach is particularly important given that benzoyl peroxide prevents bacterial resistance while clindamycin provides anti-inflammatory effects 2, 7.