Comparative Trial of Silver Nanoparticle Gel and 1% Clindamycin Gel when Use in Combination with 2.5% Benzoyl Peroxide in Patients with Moderate Acne Vulgaris
Natthachat Jurairattanaporn MD*, Thep Chalermchai MD, PhD**, Suwirakorn Ophaswongse MD**, Montree Udompataikul MD**
Affiliation : * Graduate student, Master of Science in Dermatology, Skin Center, Srinakharinwirot University, Bangkok, Thailand ** Skin Center, Srinakharinwirot University, Bangkok, Thailand
Background : Treatments of acne vulgaris commonly use antimicrobials and comedolytic agents. Considering bacterial
resistance to topical antibiotics, the alternative treatment such as silver manufactured into nanoparticle receives an atten-
tion. Silver nanoparticle has an antibacterial effect against Propionibacterium acnes and anti-inflammation. Clinical study
of silver nanoparticle gel for the treatment of acne vulgaris is limited.
Objective : To compare the efficacy and safety between silver nanoparticle gel and 1% clindamycin gel both combine with
2.5% benzoyl peroxide for the treatment of moderate severity of acne vulgaris.
Material and Method: This was an experimental, double-blinded, randomized-controlled study. Sixty-four moderately severe
acne patients were enrolled. They were randomized to receive either silver nanoparticle gel with 2.5% benzoyl peroxide or
clindamycin gel with 2.5% benzoyl peroxide (32 patients each). The clinical outcomes were evaluated for inflammatory and
non-inflammatory acne count, acne redness, the patients’ satisfaction and patients’ Dermatology Life Quality Index (DLQI)
at the baseline, 2, 4, 6 and 8-week visit.
Results : After 8 weeks of follow-up period, the average mean percent change from the baseline of non-inflammatory and
inflammatory acne counts were gradually declined in both silver nanoparticle and clindamycin group. At the study endpoint
(8-week visit), average mean percent change from the baseline of inflammatory acne count was slightly better reduction in
silver nanoparticle group (79.7%) than clindamycin group (72.6%) with no significant difference (p = 0.18). The average mean
percent change from the baseline of non-inflammatory acne count reduction was also no difference from silver nanoparticle
and clindamycin group (61.1% and 66.8% respectively, p = 0.22). For clinical erythema score and Mexameter erythema
index to evaluate acne redness were no statistical difference between the 2 groups. Moreover, the patients’ satisfaction to
study medication and their quality of life of patients (DLQI score) were reported with better improvement from the baseline in
both groups but there was no statistical significant difference. Except for average mean, patients’ satisfaction to acne severity
at 6-week visit showed that silver nanoparticle group had better satisfaction score than clindamycin group (4.6±0.6 vs.
4.2±0.6) with statistical significance (p = 0.01). Common adverse effects were skin dryness (28.1%) and skin irritation (4.7%)
which might be caused by 2.5% benzoyl peroxide. There was no adverse effect for silver nanoparticle gel from the present study.
Conclusion : Silver nanoparticle gel is effective with good safety profile for the treatment of acne vulgaris. The present study
demonstrated that there were no clinical significant differences between silver nanoparticle gel and clindamycin gel for
the treatment of moderate severity of acne vulgaris when use in combination with 2.5% benzoyl peroxide. The clinical
application as alternative treatment for acne is advised.
Keywords : Silver nanoparticle, 2.5% Benzoyl peroxide, Clindamycin, Acne vulgaris
