EFFICACY OF TOPICAL METFORMIN VERSUS TOPICAL CLINDAMYCIN IN THE TREATMENT OF ACNE VULGARIS: A SPLIT-FACE STUDY

Abstract

Background: Acne vulgaris is a common inflammatory dermatosis that affects adolescents and adults, often requiring effective topical therapies. Objective: To evaluate and compare the efficacy of 30% topical metformin cream with 2% topical clindamycin in the management of mild to moderate acne vulgaris using a split-face study design. Methods: The quasi-experimental study was performed in the Department of Dermatology, Ghurki Trust Teaching Hospital, Lahore. Sixty subjects (120 facial sides) with a mean age of 22.14 ± 5.48 years (age range 14–36 years), having mild to moderate facial acne, were selected. The patients used 30% metformin cream on the right cheek and 2% topical clindamycin on the left cheek for 12 weeks and were followed for 16 weeks. The lesion count (total, inflammatory, and non-inflammatory) was recorded at baseline, week 4, week 8, week 12, and week 16. Both interventions showed significant efficacy against acne lesions; however, metformin exhibited higher efficacy, especially for inflammatory lesions. By week 12, metformin significantly outperformed clindamycin in reducing inflammatory lesions (5.13 ± 2.46 vs. 6.89 ± 3.23; p < 0.001) and total lesion counts (14.09 ± 6.21 vs. 15.87 ± 6.73; p = 0.017). At week 16, metformin maintained superior improvement, with lower total lesion counts (8.42 ± 5.38 vs. 10.82 ± 5.48; p < 0.001), inflammatory lesions (2.60 ± 1.66 vs. 4.58 ± 2.69; p < 0.001), and non-inflammatory lesions (5.93 ± 4.79 vs. 6.82 ± 5.09; p = 0.011). The Global Acne Assessment Score (GAAS) was also in favor of metformin, as 60.0% of metformin-treated sides obtained "Almost clear" status after 12 weeks, while 18.3% of sides treated with clindamycin did. After 16 weeks, 96.7% of metformin treated sides versus 83.3% of sides treated with clindamycin had obtained "Almost clear" status, which shows superior and sustained effectiveness of metformin. Conclusion: It is concluded that topical 30% metformin cream was more effective than topical 2% clindamycin in lowering lesion numbers and GAAS scores.