Clindamycin Gel for Acne: How It Works, Why It Is Paired With Benzoyl Peroxide, Side Effects and Cost

Clindamycin gel is a prescription topical antibiotic for acne. In the US it comes as a 1% gel, lotion, solution and foam, and in fixed combinations with benzoyl peroxide (Duac, Acanya, Onexton and generics of BenzaClin), with tretinoin (Ziana, Veltin) and, since October 2023, with adapalene and benzoyl peroxide in one gel (Cabtreo). The American Academy of Dermatology's 2024 guideline strongly recommends topical antibiotics but says they should not be used alone, because acne bacteria become resistant. That is why most prescriptions now pair clindamycin with benzoyl peroxide.

This guide covers what the US labels say about clindamycin gel: how to apply it, who must not use it, the colitis warning, side effects with the label's own numbers, and what the combination trials showed against each ingredient on its own. It also covers erythromycin and minocycline foam briefly, what resistance studies found, how long treatment usually runs, and what these products cost. Oral antibiotics for acne are covered separately in our doxycycline for acne guide. We sell Indian clindamycin gels, so we have a commercial interest; every number here comes from the sources listed at the end, opened on 28 October 2026.

Clindamycin gel at a glance

Question	What the US labels and guideline say
What it treats	Acne vulgaris (Cleocin T, Clindagel and generic labels)
Strength	1% clindamycin (10 mg per gram or mL), as clindamycin phosphate
How often	Cleocin T gel and lotion, and generic solution: twice daily. Clindagel (and its generics) and clindamycin foam: once daily
Age	Safety and effectiveness under age 12 not established
Must not use	History of regional enteritis (Crohn's disease), ulcerative colitis or antibiotic-associated colitis; allergy to clindamycin or lincomycin
Main warning	Diarrhea, bloody diarrhea and colitis have been reported with topical clindamycin; stop if significant diarrhea occurs
Use alone?	AAD 2024: topical antibiotic monotherapy is not recommended; pair with benzoyl peroxide
US pharmacy cost	Generic twice-daily 1% tube gel: $0.14183 per gram; generic once-daily 1% gel (75 mL bottle): $3.62523 per mL (NADAC, week of 28 October 2026)

What clindamycin gel is and the forms sold in the US

Clindamycin is a lincosamide antibiotic. On the skin it is used as clindamycin phosphate, an inactive ester that the body converts to active clindamycin. Every topical form sold in the US contains the same amount of drug: clindamycin phosphate equivalent to 10 mg of clindamycin per gram or per mL, written as 1%. Combination labels write the salt instead, so "clindamycin phosphate 1.2%" on Duac, Acanya, Onexton, Ziana and Cabtreo is also 1% clindamycin.

Product	Form	Label dosing	Drugs@FDA status (openFDA, 28 October 2026)
Cleocin T (Pfizer)	Gel and lotion (Cleocin T solution and pledgets are listed as discontinued in Drugs@FDA; generic clindamycin solution and pledgets are sold)	Twice daily	Gel NDA 050615 and lotion NDA 050600: prescription
Clindagel (Bausch)	Gel, 75 mL bottle	Once daily	NDA 050782: prescription
Evoclin and generic foam	Foam, 50 g or 100 g can	Once daily	Evoclin NDA 050801 discontinued; generic foam sold (Sun Pharmaceutical label, July 2026)
Generic clindamycin phosphate gel, lotion, solution	Several makers	Per each label	Prescription

All of them are prescription only in the US. The solution and foam contain alcohol and are flammable, so the labels say to avoid fire, flame and smoking during and right after application.

How clindamycin works on acne

Clindamycin stops bacteria making proteins by binding to the 50S subunit of the bacterial ribosome. It is bacteriostatic: it stops growth rather than killing outright. The Cleocin T label says clindamycin is active in the lab against most isolates of the acne bacterium (then called Propionibacterium acnes, now Cutibacterium acnes), and the Clindagel label reports that clindamycin inhibited all the C. acnes cultures it tested at 0.4 mcg/mL. The same Cleocin T label is candid that "the mechanism of action of clindamycin in treating acne vulgaris is unknown". The trials below report results for inflamed spots (papules and pustules) and for blackheads and whiteheads separately.

How much reaches the bloodstream

Very little, but not none, which matters for the colitis warning below. With repeated use of the 1% solution, the Cleocin T label reports serum clindamycin of 0 to 3 ng/mL and less than 0.2% of the dose recovered in urine. In a study of 24 people applying about 3 to 12 grams of Clindagel a day for 5 days, peak plasma levels stayed below 5.5 ng/mL and less than 0.04% of the dose appeared in urine. The foam label compared foam and gel directly: on day 5, peak level and total exposure were 23% and 9% lower with the foam.

How to apply clindamycin gel

• Cleocin T gel or lotion, and generic clindamycin solution or pledgets: apply a thin film twice daily to the affected area. Shake the lotion first. Each pledget is used once and thrown away.
• Clindagel: apply a thin film once daily to the skin where acne appears, using enough to cover the whole area lightly.
• Clindamycin foam: once daily after washing with mild soap and letting the skin dry fully. Dispense into the cap or onto a cool surface, then wash your hands.
• Treat the whole area where acne appears, not single spots.
• Keep it away from the eyes, mouth and broken skin. The alcohol solution burns the eyes; rinse with plenty of cool tap water if it gets there.

If you also use a retinoid such as tretinoin or adapalene, your prescriber will tell you how to time the two. Our guide on how to use tretinoin covers the retinoid side.

Who should not use clindamycin gel

The Cleocin T and Clindagel labels use the same wording: they are "contraindicated in individuals with a history of hypersensitivity to preparations containing clindamycin or lincomycin, a history of regional enteritis or ulcerative colitis, or a history of antibiotic-associated colitis." Regional enteritis is Crohn's disease. The foam label lists regional enteritis, ulcerative colitis and antibiotic-associated colitis (including pseudomembranous colitis). These contraindications carry over to every clindamycin combination product.

The labels also say clindamycin should be prescribed with caution in atopic individuals, and that use under age 12 has not been studied enough to establish safety.

The colitis warning, in the label's words

This is the warning that sets clindamycin apart from other acne creams. From the Cleocin T label: "Use of the topical formulation of clindamycin results in systemic absorption from the skin surface. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin." The label adds that orally and parenterally given clindamycin "has been associated with severe colitis which may result in patient death", that "when significant diarrhea occurs, the drug should be discontinued", and that anti-diarrhea medicines such as opiates and diphenoxylate with atropine "may prolong and/or worsen the condition". Because of this risk, the Cleocin T and Clindagel labels say in their indication that the prescriber "should consider whether other agents are more appropriate."

The adverse reactions section says these bowel problems have been reported "rarely with topical clindamycin". Toxin from Clostridioides difficile is one primary cause of this colitis, which typically shows as severe, persistent diarrhea with severe cramps, sometimes with blood and mucus. The foam label's patient leaflet tells users to stop and call their doctor for severe stomach cramps, watery diarrhea or bloody diarrhea during treatment and for several weeks after.

Side effects of clindamycin gel: label numbers

Skin reactions are the common ones. The Cleocin T label pools 18 clinical studies of its solution, gel and lotion. These were not split against a vehicle, so they show how often each event was reported, not how much was caused by the drug.

Reported event	Solution (553 people)	Gel (148 people)	Lotion (160 people)
Dryness	19%	23%	18%
Erythema (redness)	16%	7%	14%
Burning	11%	10%	11%
Itching	7%	10%	11%
Peeling	11%	not recorded	7%
Oiliness or oily skin	1%	18%	10% (12 of 126)

Where there was a vehicle comparison, clindamycin itself added little irritation. In the Clindagel trial (168 on Clindagel, 84 on vehicle gel), pruritus and peeling were each reported by 1 person on Clindagel (0.6%). In the foam trials, burning, itching and dryness were no more common than with the plain foam:

Adverse reaction	Clindamycin foam (439)	Vehicle foam (154)
Headache	12 (3%)	1 (1%)
Application site burning	27 (6%)	14 (9%)
Application site pruritus	5 (1%)	5 (3%)
Application site dryness	4 (1%)	5 (3%)
Application site reaction, not otherwise specified	3 (1%)	4 (3%)

The labels also list abdominal pain, gastrointestinal disturbances, gram-negative folliculitis, eye pain and contact dermatitis as reported with topical clindamycin. In a contact sensitization study, 4 of 200 people showed signs suggesting allergic contact sensitization to Clindagel.

How well clindamycin gel works on its own

Two single-ingredient labels report vehicle-controlled trials.

Trial (12 weeks, once daily)	Clindamycin	Vehicle
Clindagel: inflammatory lesions, mean reduction	51% (162 people)	40% (82 people)
Clindagel: noninflammatory lesions	25%	12%
Clindagel: total lesions	38%	27%
Foam: clear or almost clear (ISGA)	31% (386 people)	18% (127 people)
Foam: inflammatory lesions, mean reduction	49%	35%
Foam: noninflammatory lesions	38%	27%

Absolute reductions were smaller for blackheads and whiteheads; the margin over vehicle was similar for both lesion types (11 to 14 points), and in the Clindagel trial only the inflammatory-lesion difference was reported as statistically significant. A modest margin over a plain gel, plus resistance, is why guidelines and newer products moved to combinations.

Why guidelines say not to use it alone

The American Academy of Dermatology's 2024 acne guideline (Reynolds et al., J Am Acad Dermatol 2024;90(5):1006.e1 to 1006.e30, PMID 38300170) makes a strong recommendation, with moderate certainty of evidence, for topical antibiotics, with this remark: "Topical antibiotic monotherapy is not recommended." In the same table it strongly recommends fixed-dose combinations of a topical antibiotic with benzoyl peroxide, and fixed-dose combinations of a topical retinoid with a topical antibiotic, adding that "concomitant use of benzoyl peroxide is recommended to prevent the development of antibiotic resistance." It also states, as good practice, that topical treatment should combine multiple mechanisms of action. Our acne treatment page shows how these pieces fit together.

Benzoyl peroxide works differently from an antibiotic, which is why the guideline pairs the two to limit resistance. A retinoid adds a third action, unblocking pores, which clindamycin does not do. If your prescription is clindamycin gel alone, it is reasonable to ask whether benzoyl peroxide should be added. Adapalene and benzoyl peroxide also come together in one gel, covered in our Epiduo gel guide.

Resistance in C. acnes: what the reviews found

Resistance is real, but the size of it depends heavily on where and when the bacteria were sampled. Two recent meta-analyses gave different pictures for clindamycin:

Review	Data	Clindamycin resistant	Erythromycin resistant
Zhu et al., Front Microbiol 2025 (PMID 40535003)	23 studies, 2,046 isolates from acne patients, 2005 to 2025	22.38%	29.20%
Beig et al., J Glob Antimicrob Resist 2024 (PMID 39179105)	39 studies	3.1%	36.6%

Zhu and colleagues found clindamycin and erythromycin resistance rising over time, and higher rates in China than elsewhere. Both reviews agree that resistance to erythromycin is common. The labels add two practical points: cross-resistance between clindamycin and erythromycin has been shown (Clindagel label), and the foam label notes that antibiotic treatment of acne can also select resistance in other skin bacteria such as Staphylococcus aureus and Streptococcus pyogenes. Our guide to antibiotic resistance explains the wider problem.

Clindamycin and benzoyl peroxide combinations sold in the US

Product	Clindamycin phosphate / benzoyl peroxide	Label dosing	Status (openFDA)
BenzaClin and generics	1% clindamycin / 5% (mixed by pharmacist)	Twice daily	BenzaClin NDA 050756 discontinued; generic kits on DailyMed (Glenmark, Northstar, Sun)
Duac and generics	1.2% / 5%	Once daily, evening	Duac NDA 050741: prescription
Acanya and generics	1.2% / 2.5%	Once daily, pea-sized amount	NDA 050819: prescription
Onexton and generics	1.2% / 3.75%	Once daily, pea-sized amount	NDA 050819: prescription

The 1.2% combination gels are kept in a refrigerator until dispensed and then have a short use-by date. The labels tell pharmacists to give a 60-day expiry for generic 1.2%/5% gel, 10 weeks for Acanya and 8 weeks for Onexton, stored at room temperature up to 25°C (77°F) once dispensed. Reconstituted 1%/5% kits keep for 3 months at room temperature.

Combination vs each ingredient: the trial results

The combination labels are useful because they tested the full product against clindamycin alone, benzoyl peroxide alone and vehicle in the same trial. Acanya's two 12-week trials, each with about 1,400 people, are the largest:

Week 12 result	Acanya	Clindamycin	Benzoyl peroxide	Vehicle
Trial 1: clear or almost clear	115 of 399 (29%)	84 of 408 (21%)	76 of 406 (19%)	29 of 201 (14%)
Trial 1: inflammatory lesions, mean reduction	55.0%	47.1%	49.3%	34.5%
Trial 2: clear or almost clear	113 of 398 (28%)	94 of 404 (23%)	94 of 403 (23%)	21 of 194 (11%)
Trial 2: inflammatory lesions, mean reduction	54.2%	45.3%	45.7%	23.3%

The generic 1.2%/5% gel (the Duac formula) was tested in five trials of 1,319 people over 11 weeks. It beat vehicle, benzoyl peroxide and clindamycin on inflammatory lesions in three of the five (Trials 1, 2 and 5). Mean reduction in inflammatory lesion counts:

Treatment	Trial 1 (120)	Trial 2 (273)	Trial 3 (280)	Trial 4 (288)	Trial 5 (358)
Clindamycin + benzoyl peroxide	65%	56%	42%	57%	52%
Benzoyl peroxide	36%	37%	32%	57%	41%
Clindamycin	34%	30%	38%	49%	33%
Vehicle	19%	-0.4%	29%	no arm	29%

Two limits from the labels are worth knowing. The 1.2%/5% gel is approved for inflammatory acne, and its label states it "has not been demonstrated to have any additional benefit when compared with benzoyl peroxide alone in the same vehicle" for non-inflammatory acne (blackheads and whiteheads). In Trial 4, benzoyl peroxide alone matched the combination. For the Onexton 1.2%/3.75% gel, the single trial was against vehicle only: 29% against 15% clear or almost clear, and 60.4% against 31.3% mean reduction in inflammatory lesions.

Side effects of the benzoyl peroxide combinations

Adding benzoyl peroxide adds dryness and peeling. In the generic 1%/5% (BenzaClin formula) trials, the most frequent adverse event was dry skin, 12% against 6% with vehicle, even though a moisturizer was provided. Application site reactions were 3% against under 1%, peeling 2%, itching 2%, redness 1% and sunburn 1%. In the Acanya trials, local skin reactions peaked around week 4 and fell close to baseline by week 12.

The combination labels add warnings of their own:

• Allergy: anaphylaxis and allergic reactions leading to hospitalization have been reported after approval. Stop and seek help for severe swelling or shortness of breath.
• Sun: benzoyl peroxide may increase sensitivity to sunlight; minimize sun, tanning beds and sun lamps after applying.
• Bleaching: the 1%/5% label says the gel may bleach hair or colored fabric, so use white pillowcases and towels.
• Other acne products: peeling, desquamating or abrasive agents used at the same time can add up to more irritation.

Clindamycin with tretinoin: Ziana and Veltin

Ziana (approved 2006) and Veltin (approved 2010) combine clindamycin phosphate 1.2% with tretinoin 0.025% in one gel. Both are prescription products. The Ziana label says to use a pea-sized amount once at bedtime, dotted on the chin, cheeks, nose and forehead and then spread over the face. The Ziana label pooled two identical trials of 2,540 people:

Week 12 result	Ziana (845)	Clindamycin (426)	Tretinoin (846)	Vehicle (423)
Clear or almost clear	21%	16%	14%	8%
Inflammatory lesions, mean reduction	48%	42%	39%	26%
Noninflammatory lesions, mean reduction	36%	27%	31%	16%

The Ziana label carries the same colitis contraindication (regional enteritis, ulcerative colitis or a history of antibiotic-associated colitis) and the tretinoin sun warning: avoid sunlight and sunlamps, and do not use it on sunburned skin until it has recovered. Because this pair has no benzoyl peroxide, the AAD guideline recommends adding benzoyl peroxide alongside. For the retinoid choice itself, see adapalene vs tretinoin.

The triple gel: Cabtreo

Cabtreo, approved by the FDA on 20 October 2023 (NDA 216632), combines clindamycin phosphate 1.2%, adapalene 0.15% and benzoyl peroxide 3.1% in one gel applied once daily, for people 12 and older. In two 12-week trials of 363 people with moderate or severe acne, success (clear or almost clear plus at least a 2-grade improvement) was 49.6% against 24.9% with vehicle in Trial 1 and 50.5% against 20.5% in Trial 2.

Three active ingredients sting more. Application site pain (including stinging and burning) was reported by 13.6% on Cabtreo against 0.8% on vehicle, redness by 4.5% against 0, and dryness by 4.1% against 0.8%. Overall 2.5% (6 of 242) stopped because of skin reactions. Its contraindications include the clindamycin bowel history list plus allergy to any of the three ingredients or lincomycin.

Erythromycin and minocycline: the other topical antibiotics

Erythromycin. Topical erythromycin is still on the US market by prescription: openFDA lists active generic erythromycin gel, solution and swabs, and erythromycin with benzoyl peroxide gel. The 2% solution label says to apply it twice daily. The problem is effectiveness. A systematic review of 50 controlled trials (Simonart and Dramaix, Br J Dermatol 2005, PMID 16086756) found a significant decrease over time in topical erythromycin's effect on inflammatory and noninflammatory lesion counts, while topical clindamycin's efficacy stayed stable; the authors linked this to antibiotic-resistant bacteria. Clindamycin labels also advise against using clindamycin and erythromycin products together, because they antagonize each other in lab studies.

Minocycline foam (Amzeeq). Approved in 2019 (NDA 212379), Amzeeq is a 4% minocycline foam for inflammatory lesions of non-nodular moderate to severe acne in people 9 and older. It is applied once daily at least 1 hour before bedtime, with no bathing, showering or swimming for 1 hour after. It is contraindicated in anyone allergic to any tetracycline, and its label carries tetracycline-class warnings about pregnancy and tooth discoloration. Unlike clindamycin, it does not list colitis history as a contraindication, but its label still warns that C. difficile-associated diarrhea, up to fatal colitis, has been reported with nearly all antibacterials, including oral minocycline.

Dapsone gel (Aczone). Dapsone is a sulfone rather than a classic topical antibiotic, and its US labels say no microbiology studies were run in its acne trials. Strengths, trial results and the blood warnings are in our dapsone gel guide.

How long to use clindamycin gel

The main trials behind the labels ran 10 to 12 weeks, so judge results at about 3 months rather than 3 weeks. The Acanya and Onexton labels state that "use beyond 12 weeks has not been evaluated." The plain clindamycin labels give no fixed course length, but the clindamycin foam label says to stop if there is no improvement after 6 to 8 weeks or if acne gets worse. Because resistance builds with exposure, ask your prescriber for a planned review point and what to continue with once the antibiotic stops. If acne keeps coming back once the antibiotic stops, that is a reason to review the whole plan with your prescriber, which may include oral options such as doxycycline or, for severe or scarring acne, isotretinoin.

Pregnancy, breastfeeding and teenagers

• Pregnancy: the Cleocin T label says systemic clindamycin in the second and third trimesters has not been associated with more congenital abnormalities, there are no adequate first trimester studies, and it should be used in the first trimester only if clearly needed. Combinations with a retinoid (Ziana, Veltin, Cabtreo) bring the retinoid's own pregnancy considerations; ask your prescriber.
• Breastfeeding: oral and injected clindamycin appear in breast milk. The Cleocin T label advises watching the infant for diarrhea, thrush or diaper rash, and if the product is used on the chest, taking care that the baby does not swallow it. The Clindagel, Ziana and clindamycin with benzoyl peroxide labels add that "because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother."
• Age: labels cover people 12 and older; safety and effectiveness below 12 are not established. Amzeeq is the exception at 9 and older.

Drug interactions and practical cautions

• Neuromuscular blockers: clindamycin can increase the effect of muscle relaxants given during surgery; the labels advise caution. Tell your anesthetist you use it.
• Erythromycin: do not combine with topical or oral erythromycin products.
• Diarrhea: report any significant diarrhea during treatment or in the weeks after.
• Flammable forms: keep the solution and foam away from flame and cigarettes.

What clindamycin gel costs in the US

The National Average Drug Acquisition Cost (NADAC) survey shows what US pharmacies pay for generic medicines. It is not the price at the counter, which adds dispensing fees and margin, and insured patients often pay a copay instead. Even so, it shows the gap between plain clindamycin and the combinations:

NADAC description (generic)	Per unit, week of 28 October 2026	Example pack at NADAC
Clindamycin phosphate 1% gel, twice-daily tube gel	$0.14183 per gram	60 g tube: $8.51
Clindamycin phosphate 1% gel, once-daily gel in a 75 mL bottle (generic Clindagel)	$3.62523 per mL	75 mL: $271.89
Clindamycin phosphate 1% solution	$0.17033 per mL	60 mL: $10.22
Clindamycin phosphate 1% lotion	$0.23227 per mL	60 mL: $13.94
Clindamycin phosphate 1% foam	$1.96947 per gram	50 g can: $98.47
Clindamycin-benzoyl peroxide 1-5% gel	$0.63315 per gram	50 g: $31.66
Clindamycin-benzoyl peroxide 1-5% pump	$0.96009 per gram	50 g: $48.00
Clindamycin-benzoyl peroxide 1.2-3.75% gel	$2.17861 per gram	50 g: $108.93
Clindamycin-tretinoin 1.2%-0.025% gel	$4.00283 per gram	30 g: $120.08
Erythromycin 2% gel	$0.66939 per gram	For comparison

No NADAC rows were found for the brands Acanya, Onexton, Ziana, Cabtreo, Duac, Clindagel or Amzeeq in the 2026 file. The plain point for US readers: the twice-daily generic 1% tube gel is cheap at the pharmacy level, while the once-daily bottle gel is not, so with insurance or a discount card the local route is often the cheapest. The combinations, especially the clindamycin and tretinoin gel, are where costs rise sharply. Our acne treatment online pharmacy guide compares the routes to treatment in the US.

Indian clindamycin gels we sell and their prices

We sell these Indian-made products. They are not US-approved versions of the brands above. Ingredient strengths are as stated in Indian pharmacy listings; prices are from our store as of 28 October 2026 and include no shipping.

Product	Contents (Indian listing)	Pack prices	Per tube / per gram
Acnesol 20g (Systopic)	Clindamycin 1% w/w gel, 20 g tube	3 tubes $24.37; 6 tubes $39.06; 12 tubes $76.56	$8.12 per tube ($0.41/g) for 3; $6.38 per tube ($0.32/g) for 12
Erytop Gel (USV)	Clindamycin 1% w/w gel, 20 g tube	3 tubes $16.25; 6 tubes $28.75; 12 tubes $53.75	$5.42 per tube ($0.27/g) for 3; $4.48 per tube ($0.22/g) for 12
Peroclin 5% Gel (Ajanta)	Benzoyl peroxide 5% + clindamycin 1%, 15 g	1 tube $20.00; 3 tubes $50.00; 6 tubes $90.00	$20.00 ($1.33/g) for 1; $15.00 ($1.00/g) for 6
Peroclin 2.5% Gel (Ajanta)	Benzoyl peroxide 2.5% + clindamycin 1%, 15 g	1 tube $18.00; 3 tubes $45.00; 6 tubes $82.00	$18.00 ($1.20/g) for 1; $13.67 ($0.91/g) for 6
Acnesol A Nano 15g (Systopic)	Adapalene 0.1% + clindamycin 1%, 15 g	3 tubes $26.25; 6 tubes $48.75; 12 tubes $93.75	$8.75 per tube ($0.58/g) for 3; $7.81 per tube ($0.52/g) for 12
Faceclin AT Gel (Abbott)	Adapalene 0.1% + clindamycin phosphate 1%	3 tubes $25.00; 6 tubes $48.75; 12 tubes $96.25	$8.33 per tube for 3; $8.02 per tube for 12

Erytop's name suggests erythromycin, but Indian listings give its active ingredient as clindamycin 1% w/w. Peroclin gels match the guideline's preferred antibiotic plus benzoyl peroxide pairing. Acnesol A Nano and Faceclin AT pair clindamycin with adapalene but contain no benzoyl peroxide, so the AAD remark about adding benzoyl peroxide applies; plain benzoyl peroxide gels such as Benzac AC 5% and Persol AC 5% are separate products. Shipping, as listed on our shipping page on 28 October 2026, is standard registered shipping at a $25 flat rate with delivery in 7 to 14 business days, free on orders of $149 or more.

Importing for personal use: the FDA's position

The FDA's personal importation page says: "In most circumstances, it is illegal for individuals to import drugs or devices into the U.S. for personal use because these products purchased from other countries often have not been approved by the FDA for use and sale in the U.S." It also says: "If a drug is approved for use in another country but is an unapproved new drug in the U.S. it is illegal to import." The page adds that the FDA cannot vouch for the safety and effectiveness of medicine bought over the internet from foreign sources, and it "recommends only obtaining medicines from legal sources in the U.S." The page describes situations in which FDA staff may use discretion, but that is not a right. If you are in the US, read the page and check your own situation before ordering, and keep your prescriber informed of everything you apply to your skin.

Choosing a product: a short summary

• Mostly red, inflamed spots: clindamycin with benzoyl peroxide is the guideline-backed pairing, as one gel or two products.
• Blackheads and whiteheads too: a retinoid targets blocked pores, and the 1.2%/5% clindamycin and benzoyl peroxide label found no added benefit over benzoyl peroxide alone for these lesions. With a retinoid and clindamycin gel, the guideline recommends benzoyl peroxide alongside.
• Sensitive skin: lower benzoyl peroxide strengths (2.5%) were used in Acanya; azelaic acid is a non-antibiotic option.
• Any history of colitis or Crohn's disease: clindamycin is contraindicated; ask about other options.
• Not better after 12 weeks: review the plan rather than staying on an antibiotic gel indefinitely.

For a side by side look at every prescription acne cream by evidence, see our prescription skin care medicine guide.

Sources

1. CLEOCIN T (clindamycin phosphate) topical solution, lotion and gel, US prescribing information, Pfizer, revised 11/2025 (DailyMed setid 4a3901a4-194f-4a15-9c85-3d0982afcf31).
2. CLINDAGEL (clindamycin phosphate) topical gel 1%, US prescribing information, Bausch Health (DailyMed setid f7b4e985-719a-4547-b624-94612d520991).
3. Clindamycin phosphate foam 1%, US prescribing information, Sun Pharmaceutical Industries, July 2026 (DailyMed setid 9dd8b4f9-9db8-4a16-abcd-bf32219e0301).
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7. ONEXTON gel 1.2%/3.75%, US prescribing information, Bausch Health (DailyMed setid 697e760a-c206-4565-8f4e-a8085e215827).
8. ZIANA gel, US prescribing information, Bausch Health, May 2026 (DailyMed setid 78c329f9-f0c9-486d-9e54-0123699fb9e1).
9. CABTREO gel, US prescribing information, Bausch Health (DailyMed setid 9468da0f-9978-4c58-8135-0274c3415084).
10. AMZEEQ (minocycline) topical foam 4%, US prescribing information (DailyMed setid cc251492-977b-4eb1-a088-a90831324bad).
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13. Reynolds R, Yeung H, Cheng C, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024;90(5):1006.e1 to 1006.e30. PMID 38300170. Recommendation table as reprinted in Medscape Guideline Essentials.
14. Simonart T, Dramaix M. Treatment of acne with topical antibiotics: lessons from clinical studies. Br J Dermatol 2005. PMID 16086756.
15. Zhu et al. Antibiotic resistance rates in Cutibacterium acnes isolated from patients with acne vulgaris: a systematic review and meta-analysis. Front Microbiol 2025. PMID 40535003.
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17. Centers for Medicare and Medicaid Services. National Average Drug Acquisition Cost (NADAC) 2026 dataset, data.medicaid.gov, rows dated 28 October 2026.
18. US Food and Drug Administration. Personal Importation, fda.gov, accessed 28 October 2026.

This guide is for information and does not replace advice from your doctor or pharmacist. Do not start, stop or combine acne medicines without speaking to your prescriber.