Duac vs Epiduo - which gel is the best for acne?
Acne, Vs

Duac vs Epiduo: Best treatment for acne?

Duac and Epiduo are two common prescription-only gels used in the treatment of acne. What is the difference between both gels? Duac vs Epiduo contrasts all necessary information about both medicines.

Duac vs Epiduo legal classification

Duac and Epiduo are both classified as prescription-only medicines (POM). POMs need to be prescribed by a GP or another prescriber.

Can you buy Duac or Epiduo?

Since both medicines are prescription-only, it is impossible to buy them without a prescription. However, many online pharmacies offer private services which enable individuals to purchase prescription-only medicines like Duac or Epiduo. Usually, it means, that patients need to complete a health questionnaire/risk assessment. Once reviewed by a doctor a private prescription is issued and the product is sold. When a medication is supplied to patients privately, patients pay for the cost of medication with an additional charge (profit) on top of the cost of medication. Some online websites may charge consultation fees/prescription fees separately. In many cases, all those charges are included in a single price to keep the process simple.

What are the main active ingredients found in Duac and Epiduo?

Both Duac and Epidu contain two active ingredients (drugs). One active ingredient, benzoyl peroxide is present in both products. The difference between Duac and Epiduo comes from the second ingredient which is different in both medicines. Alongside benzoyl peroxide, Duac contains clindamycin phosphate (antibiotic), whereas Epidu contains adapalene (a topical retinoid).

Both Duac and Epiduo come in two different strengths:

Duac Once Daily Gel Epiduo Gel
Duac Once Daily gel 1%/3% contains:

1% of clindamycin and 3% of benzoyl peroxide.

 

Duac Once Daily gel 1%/5% contains:

1% of clindamycin and 5% benzoyl peroxide.

 

Epiduo 0.1%/2.5% Gel contains:

0.1% of adapalene and 2.5% of benzoyl peroxide.

 

Epiduo 0.3% / 2.5% gel contains:

0.3% of adapalene and 2.5% of benzoyl peroxide.

 

 

What is the role of each active ingredient in the management of acne?

Duac Once Daily Gel (clindamycin & benzoyl peroxide)

Clindamycin is classified as an antibiotic. Antibiotics are commonly used in the treatment of acne to prevent the growth of bacteria. Acne is characterised by hypersensitivity of the sebaceous glands to the presence of sex hormones (androgens). Symptoms of acne are aggravated by the presence of bacteria such as P. acnes and inflammation (Motosko et al, 2019).

Guideline on the management of acne recommends that topical antibiotics (e.g. clindamycin) are always used together in combination with benzoyl peroxide.

Benzoyl peroxide is a compound that has antibacterial actions and anti-inflammatory properties (Tanghetti, 2008). Benzoyl peroxide has keratolytic properties and helps to peel away dead skin (GSK, 2019).

Epiduo (adapalene & benzoyl peroxide)

Benzoyl peroxide is included in Epiduo’s formulation for the same reasons as discussed in the previous paragraph. The second ingredient, adapalene is classified as (third generation) topical retinoid. Topical retinoids are Vitamin A derivatives. Retinoids such as adapalene control acne symptoms in two ways: firstly they prevent microcomedone formation and thus stop the formation of acne lesions and secondly help with inflammation (redness and swelling) associated with acne (Chivot, 2005).  

Are Duac and Epiduo preferred medicines in the management of acne?

The NICE guideline which provides advice and treatments to doctors and other prescribers recommends the following drugs in the treatment of acne (NICE, 2021):

The choice of first-line (preferred) treatment depends on the severity of the acne and the patient’s preference. Initially, patients are offered a 12-week course with one of the following drugs:

  • topical combination of adapalene with benzoyl peroxide (Epiduo) for any acne severity
  • topical combination of tretinoin with clindamycin for any acne severity
  • topical combination of benzoyl peroxide with topical clindamycin (Duac) for mild to moderate acne
  • topical combination of adapalene with topical benzoyl peroxide together with an oral antibiotic like doxycycline or lymecycline for moderate to severe acne
  • topical azelaic acid with an oral antibiotic, either oral lymecycline or oral doxycycline for moderate to severe acne.

Related post:

Both Epiduo and Duac Once Daily gel are considered preferred, first-line treatments for acne. Epiduo can be prescribed for treatment of any severity of acne, whereas Duac in mild to moderate acne.

Duac vs Epiduo: age restrictions

Epiduo gel can be prescribed to adults and children over 9 years of age.

Duac Once Daily gel can be used by adults and children over 12 years of age.

Generally, GP would stick to the above-licensed age restrictions when prescribing either of the gels to treat acne. Occasionally GP or another doctor specialising in skin conditions may prescribe a medication outside of recommended age, making the treatment ‘unlicensed’. Prescribing unlicensed medication is not the preferred method of treatment unless another option for the treatment does not exist.

Duac vs Epiduo: possible side effects

Duac and Epiduo have similar possible side effects.

Common side effects possible with Epiduo use (emc, 2021):

  • eczema
  • atopic dermatitis
  • skin burning sensation
  • skin irritation

Duac Once Daily gel possible very common and common side effects (emc, 2020):

  • peeling
  • dryness
  • erythema (reddening of the skin)
  • burning sensation

Which gel is better: Duac or Epiduo?

Topical combination treatments of acne (Duac, Epiduo and other drugs) are considered most effective for the management of moderate to severe acne (Mavranezouli et al, 2022). One of the best ways of finding out about the effectiveness of medicines is by analysing a large amount of information taken from different studies and clinical trials. The results of this analysis are published in form of systemic reviews.

A recent systemic review which included 40 clinical trials and a total of 18089 patients looked at the effectiveness of topical medicines for the treatment of mild to moderate acne (Stuart et al, 2021).

According to the review combination of benzoyl peroxide with adapalene (Epiduo) and benzoyl peroxide with clindamycin (Duac) was more effective than benzoyl peroxide alone.

A combination of benzoyl peroxide with adapalene (Epiduo) was found to be the most effective treatment for acne (ibid).

References:

Chivot M. Retinoid therapy for acne. A comparative review. Am J Clin Dermatol. 2005;6(1):13-9. Available at: https://doi.org/10.2165/00128071-200506010-00002 Accessed on 29/10/2022

emc (2020). SmPC: Duac Once Daily 10mg/g + 50mg/g Gel. Available at: https://www.medicines.org.uk/emc/product/6/smpc#UNDESIRABLE_EFFECTS Accessed on 30/10/2022

emc (2021). SmPC: Epiduo 0.3% / 2.5% gel. Available at: https://www.medicines.org.uk/emc/product/11180/smpc#UNDESIRABLE_EFFECTS Accessed on 30/10/2022

GSK (2019). Duac – Mode of Action (video). Available at: https://gskpro.com/en-gb/products/Duac/videos/moa/ Accessed on 28/10/2022

Mavranezouli I, Daly CH, Welton NJ, Deshpande S, Berg L, Bromham N, Arnold S, Phillippo DM, Wilcock J, Xu J, Ravenscroft JC, Wood D, Rafiq M, Fou L, Dworzynski K, Healy E. A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Br J Dermatol. 2022 Jul 5. doi: 10.1111/bjd.21739. Epub ahead of print. PMID: 35789996. Available at: https://doi.org/10.1111/bjd.21739 Accessed on 30/10/2022

Motosko CC, Zakhem GA, Pomeranz MK, Hazen A (2019). Acne: a side-effect of masculinizing hormonal therapy in transgender patients. Br J Dermatol. 2019 Jan;180(1):26-30 Available at: https://doi.org/10.1111/bjd.17083 Accessed on 28/10/2022

NICE (2021). Acne vulgaris: management. Available at: https://www.nice.org.uk/guidance/ng198 Accessed on 28/10/2022 

Stuart B, Maund E, Wilcox C, Sridharan K, Sivaramakrishnan G, Regas C, Newell D, Soulsby I, Tang KF, Finlay AY, Bucher HC, Little P, Layton AM, Santer M. Topical preparations for the treatment of mild-to-moderate acne vulgaris: a systematic review and network meta-analysis. Br J Dermatol. 2021 Sep;185(3):512-525. doi: 10.1111/bjd.20080. Epub 2021 Jun 16. PMID: 33825196. Available at: https://doi.org/10.1111/bjd.20080 Accessed on 30/10/2022

Tanghetti E (2008). The evolution of benzoyl peroxide therapy. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19202772 Accessed on 01/01/20 Accessed on 28/10/2022

 

I am a qualified pharmacist working in an independent pharmacy in the UK.
Posts created 85

Leave a Reply

Your email address will not be published. Required fields are marked *

Related Posts

Begin typing your search term above and press enter to search. Press ESC to cancel.

Back To Top