These authors examined the effectiveness of topical antimicrobials such as benzoyl peroxide and clindamycin to reduce the levels of Cutibacterium in the skin of the upper backs of 12 volunteers (10 men and 2 women). The upper back of each subject was randomized into 4 treatment quadrants: topical benzoyl peroxide, topical clindamycin, combination topical benzoyl peroxide and clindamycin, and a negative control. The corresponding topical agents were applied to each site twice daily for 3 days.
A 3-mm dermal punch biopsy specimen was obtained from each site and cultured for 14 days to assess for C acnes growth. Positive cultures were assessed for the hemolytic phenotype.
C acnes grew in 4 of 12 control sites (33.3%), 1 of 12 benzoyl peroxide sites (8.3%), 2 of 12 clindamycin sites (16.7%), and 2 of 12 combination benzoyl peroxide–clindamycin sites (16.7%).
The C acnes hemolytic phenotype was present in 2 of 12 control specimens (16.7%) compared with 0 (0.0%) in the benzoyl peroxide group, 2 of 12 (16.7%) in the clindamycin group, and 2 of 12 (16.7%) in the combination benzoyl peroxide–clindamycin group. There were no statistically significant differences between treatment arms.
Comment: The lack of statistically significant differences between the treatment groups results from the small number of subjects leading to a lack of statistical power. For example, a post hoc comparison of control vs BPO has a statistical power of only 31%, rather than the desired 80%. A sample size calculation indicates that a study with 40 subjects would show a significant difference.
While this study shows that topical agents did not always eliminate Cutibacterium from the dermis, the apparent reduction in the number of positive cultures may be of clinical interest and importance. Of note, the authors noted no adverse reactions to any of the topical agents.
It seems that the role of topical agents in reducing levels of Cutibacterium merits further study.
It seems that the role of topical agents in reducing levels of Cutibacterium merits further study.
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