Clindamycin and benzoyl peroxide gel: how it works

Clindamycin and benzoyl peroxide gel is a prescription acne medicine that puts two treatments in one tube: clindamycin, an antibiotic, and benzoyl peroxide, which also kills acne bacteria. It needs a prescription from a doctor or other prescriber in the U.S. This guide explains what the gel is for, why the two ingredients are combined, how the labels say to use it, what side effects to expect, and how to store it. For benzoyl peroxide on its own, see the benzoyl peroxide guide.

Skinli is not a doctor and cannot prescribe. This guide gives general education. Your prescriber and pharmacist are the right people to decide whether this gel suits you and how you should use it.

What the gel is

DailyMed, the U.S. National Library of Medicine's database of drug labels, lists several versions. All the ones Skinli read are filed as prescription drug labels:

Strength (clindamycin / benzoyl peroxide)	Approved for	Directions on the label
1.2% / 2.5% gel	Acne, ages 12 and older	A pea-sized amount to the face once daily
1.2% / 3.75% gel	Acne, ages 12 and older	A pea-sized amount to the face once daily
1.2% / 5% gel	Red, swollen acne, ages 12 and older	A thin layer to the face once daily, in the evening

The "1.2%" is clindamycin phosphate, which the labels say is equal to 1% clindamycin. The American Academy of Dermatology (AAD) gives two examples of these gels: one with "5% benzoyl peroxide and 1% clindamycin" and one with "2.5% benzoyl peroxide and 1.2% clindamycin."

NICE, which writes acne guidance for England, lists "a fixed combination of topical benzoyl peroxide with topical clindamycin for mild to moderate acne" among its first choices, "applied once daily in the evening."

Why an antibiotic is paired with benzoyl peroxide

Antibiotics can stop working when bacteria become resistant to them. The AAD explains why dermatologists pair them: "When a topical antibiotic is part of your treatment plan, you'll use it along with an acne medication or wash that contains benzoyl peroxide. Doing so reduces your risk of developing antibiotic resistance, a condition that occurs when medications created to kill bacteria no longer work."

Benzoyl peroxide acts on bacteria in a different way. The labels call it "an oxidizing agent with bactericidal and keratolytic effects," meaning it kills bacteria and loosens dead skin cells. In a 2008 study, a 6% benzoyl peroxide cleanser lowered acne bacteria that resisted erythromycin, tetracycline and clindamycin just as much as bacteria that did not. The 2024 acne guideline of the American Academy of Dermatology lists "combining topical therapies with multiple mechanisms of action" as good practice.

The AAD says combined gels help "you get the right dose of each medication" and let you treat more than one cause of acne with one product.

What the trials found

The labels report the trials behind each gel.

1.2%/5% gel. In five trials with 1,319 people, the gel was used once daily in the evening for 11 weeks. The average drop in red pimples was 42% to 65% with the combined gel, 32% to 57% with benzoyl peroxide alone, and 30% to 49% with clindamycin alone. The label states a limit: for blackheads and whiteheads, the gel has shown no added benefit over benzoyl peroxide alone in the same gel base.

1.2%/2.5% gel. In the first of two 12-week trials:

Result at week 12	Combined gel	Clindamycin alone	Benzoyl peroxide alone	Gel without medicine
Clear or almost clear	29%	21%	19%	14%
Drop in red pimples	55.0%	47.1%	49.3%	34.5%
Drop in blackheads and whiteheads	45.3%	38.0%	40.2%	28.6%

Every group improved, including the group on a gel without medicine. The combined gel did best on each measure, and benzoyl peroxide alone and clindamycin alone gave similar results. For timelines across all benzoyl peroxide products, see the before and after guide.

How to use it

Follow your prescription. These are the steps the labels give:

1. Wash gently. One label says to wash "with a mild soap, rinse with warm water, and pat the skin dry." Another label says its trial users were told to "wait 10 to 20 minutes" after washing before applying.
2. Use the right amount. The 1.2%/2.5% and 1.2%/3.75% labels say "a pea-sized amount" for the face. The 1.2%/5% label says "a thin layer."
3. Once a day. The labels Skinli read say once daily, with the 1.2%/5% gel in the evening. MedlinePlus, last revised in 2016, describes use twice a day. Your prescription label is the one to follow.
4. Avoid the eyes, mouth, lips and broken skin.
5. Moisturize if you need to. MedlinePlus says to "ask your doctor or pharmacist to recommend a moisturizer to keep your skin soft during treatment." A small 2012 study applied a ceramide moisturizer before a 1.2%/2.5% gel. The moisturizer guide covers the order.
6. Protect from sun. The labels say to "minimize sun exposure (including use of tanning beds or sun lamps) following drug application."

The AAD warns that "applying more than your dermatologist recommends will not clear acne faster."

Side effects

The most common side effects are on the skin. The 1.2%/5% label says the most common are "erythema, peeling, dryness, and burning," meaning redness, peeling, dryness and burning. In its five trials:

Reaction during treatment	Mild	Moderate	Severe
Redness	26%	5%	0
Peeling	17%	2%	0
Dryness	15%	1%	0
Burning	5%	under 1%	0

Some of this redness was there before treatment began: 28% had mild redness at the start. The 1.2%/2.5% label says most skin reactions "increased and peaked around Week 4" and fell to near their starting levels "by Week 12." The AAD lists possible side effects of these gels as "dryness, irritated skin, peeling, burning, and worsening acne." The purging guide covers early flares.

The gel also bleaches: the labels say it "may bleach hair or colored fabric." The bleaching guide explains how to protect towels and pillowcases.

Serious warnings

These warnings appear on the labels. Your prescriber should know about them before you start.

• Colitis. The labels say diarrhea, bloody diarrhea and colitis have been reported with clindamycin, both when it is put on the skin and when it is taken by mouth or injection. Colitis is inflammation of the large bowel. The patient leaflet says to "stop using clindamycin phosphate and benzoyl peroxide gel and call your healthcare provider right away if you have severe watery diarrhea, or bloody diarrhea." The labels say not to use the gel if you have had regional enteritis, ulcerative colitis or colitis after antibiotics.
• Allergic reactions. "Anaphylaxis, as well as allergic reactions leading to hospitalization, has been reported." The leaflet says to stop and "get help right away" for "severe itching," "swelling of your face, eyes, lips, tongue, or throat," or "trouble breathing."
• Erythromycin. The labels say to avoid using the gel with products that contain erythromycin, another antibiotic.

Pregnancy and breastfeeding

The 1.2%/2.5% label says "there are no available data" on the gel in pregnant women. The 1.2%/5% label says to use it in pregnancy "only if the potential benefit justifies the potential risk to the fetus." For breastfeeding, the labels say there are no data on the gel in human milk, and that if it is used on the chest, "care should be taken to avoid accidental ingestion by the infant." Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding. MedlinePlus says to call your doctor if you become pregnant while using it.

Storage and expiry

The gels are kept cold at the pharmacy and at room temperature at home.

Strength	At home	Throw away
1.2% / 2.5%	At or below 77°F (25°C), do not freeze, store pump upright	10 weeks after it is dispensed
1.2% / 3.75%	At or below 77°F (25°C), do not freeze, store pump upright	8 weeks after it is dispensed
1.2% / 5%	Room temperature up to 77°F (25°C), do not freeze	60 days after it is dispensed

Your pharmacy label shows the exact date. Keep the tube or pump closed.

Using it with other acne products

The gel can be paired with a retinoid. In a small 2012 study, people used a 1.2%/2.5% gel in the morning and tretinoin 0.05% gel in the evening, each after a ceramide moisturizer. Some prescription gels combine a retinoid with benzoyl peroxide instead; the retinoid with benzoyl peroxide guide covers those. For store products, the FDA label for benzoyl peroxide warns that irritation is more likely when two acne medicines are used together, so ask your prescriber before adding anything.

When this gel may be the next step

If you have used benzoyl peroxide 2.5% steadily for 12 weeks and still have many red pimples, ask a doctor whether a combination gel or another prescription fits. Skinli's 12-week plan uses store benzoyl peroxide 2.5% gel with adapalene 0.1% gel, and it sends people who used both steadily for 12 weeks without improvement to a doctor. If you already use a prescription, Skinli's plan tells you to keep using it as your doctor directed and to ask your doctor before you add anything. Try the free Skinli acne plan for a plan built from a photo of your skin. Skinli gives general education. A doctor is the right person to diagnose and treat your skin.