A double blind randomized study to compare efficacy of 5% Dapsone gel vs combination of Adapalene-clindamycin gel in the treatment of mild to moderate Acne vulgaris

Background: Acne vulgaris is a disorder of the pilosebaceous glands affecting mainly the adolescent population and it is associated with significant morbidity.Aim: To compare the efficacy of 5% Dapsone gel against a combination of 1% clindamycin-0.1% adapalene gel in the treatment of mild to moderate acne vulgaris. Materials and methods:Clinically diagnosed cases of Acne vulgaris were evaluated using Global Acne Grading system (GAGS) and those classified as mild to moderate were included in the study.Dapsone 5% gel and combination of 1% clindamycin-0.1% adapalene gel were repacked in similar looking containers.Patients received the medication randomly such that 30 of them applied 5% dapsone gel and other 30 applied a combination of clindamycin-adapalene (AC) gel.They were reviewed at 4th week and their GAGS score were recorded.Results: This study comprised of 60 subjects of which, 48(80%) were men and 12(20%) women.24subjects followed up after 4weeks.Out of 24(40%), 14(58%) had improved as reflected by Wilcoxon signed rank test.Of these 14, 7 belonged to Dapsone and 7 others to clindamycin adapalene.The other 36(60%) subjects who couldn't follow-up in person were questioned telephonically.6(35%) out of 17(47%) from the adapalene clindamycin (AC) group and 5(26%) out of 19(53%) from the dapsone group said their acne had improved.2 out of 17 from AC group and 8out of 19 from Dapsone group said they did not find any improvement with the medication and had thus not returned for follow up. 2 out of 17 from AC group and 1 out of 19 from dapsone group had skin irritation and or erythema due to which they dropped out of the study.7 out of 17 from AC group and 5 out of 19 from Dapsone group, said they had not used the drugs regularly because of exams, travel and other reasons.Conclusion: Adapalene-clindamycin group showed good efficacy and lesser side effects compared to the dapsone group.This study also highlights the fact that acne cases are poorly compliant with therapy.Larger studies are required to analyze the reasons for poor compliance in acne as well as efficacy and tolerability of various newer anti acne preparations.