A comparative study of efficacy and safety of topical clindamycin 1% gel versus topical dapsone 5% gel in acne vulgaris over face: a prospective randomized double-blind study

Background: Acne vulgaris is a common chronic condition in both adolescents and adults. While 1% clindamycin gel is a standard topical treatment, increasing antibiotic resistance limits its long-term use. Dapsone 5% gel, with anti-inflammatory and antimicrobial properties, is a potential alternative. This study compared the efficacy and safety of 5% dapsone gel versus 1% clindamycin gel in mild-to-moderate acne. Methods: This 12-month prospective, randomized, double-blind study was conducted at the dermatology OPD, J.A. Group of Hospital, Gwalior, from November 2023 to October 2024. Eighty patients with facial acne were equally randomized into two groups: group 1 received clindamycin 1% gel; group 2 received dapsone 5% gel. Treatment was applied once daily at night for 12 weeks. Efficacy was assessed at baseline and weeks 4, 8, and 12 using the investigator’s global assessment (ISGA) and total lesion count (TLC). Safety and adverse drug reactions (ADRs) were recorded. The Hindi version of the Cardiff acne disability index (CADI) assessed psychosocial impact. Results: Both groups showed significant improvement by week 12. Final ISGA scores were similar (clindamycin: 1.189±0.397; dapsone: 1.184±0.392; p=0.913). Lesion count reductions were also comparable (p=0.148). Dapsone was more effective for inflammatory lesions- papules (p=0.001) and pustules (p=0.000). Comedone reduction, ADRs (p=0.555), and CADI improvements (p=0.213) were similar. Conclusions: Dapsone 5% gel showed efficacy comparable to clindamycin 1%, with superior results for inflammatory lesions. Both were well tolerated and improved quality of life, making dapsone a promising alternative.