Duac

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Duac on Prescriptsy

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Duac Once Daily Gel is a prescription-only topical treatment for acne vulgaris containing clindamycin 1% (as clindamycin phosphate) and benzoyl peroxide 5%.

It is licensed in the United Kingdom for the treatment of mild to moderate acne where comedones (blackheads and whiteheads), inflammatory papules, and pustules are present.

Duac combines an antibiotic with a powerful antimicrobial oxidising agent in a single formulation, providing effective antibacterial and anti-inflammatory action while reducing the risk of antibiotic resistance.

Acne vulgaris is one of the most common skin conditions in the UK, affecting up to 95% of people aged 11 to 30 to some degree.

While often dismissed as a cosmetic concern, acne causes significant physical discomfort and can have a profound impact on self-esteem, mental health, and quality of life.

Inflammatory acne, characterised by red, swollen papules and pus-filled pustules, results from a combination of excess sebum production, abnormal follicular keratinisation, colonisation by Cutibacterium acnes (C.

acnes), and the resulting inflammatory immune response. Duac addresses two of these factors directly: bacterial colonisation and inflammation.

This page provides a comprehensive clinical overview of how Duac works, who it is suitable for, how to use it correctly, expected treatment timelines, side effects, important safety information, and how to obtain a prescription in the UK.

Important safety information about Duac gel

Before using Duac, note the following essential safety points.

• Duac is a prescription-only medicine (POM). Use it only as directed by your prescriber.
• Benzoyl peroxide bleaches hair, clothing, towels, and bedding. Use white or old fabrics during treatment and allow the gel to dry fully before contact with coloured materials.
• Benzoyl peroxide increases sun sensitivity. Use a non-comedogenic sunscreen with SPF 30 or higher and avoid prolonged sun exposure and sunbeds.
• Do not use Duac if you have a history of antibiotic-associated colitis (Clostridioides difficile infection).
• If you develop persistent or severe diarrhoea during or after using Duac, stop the gel and seek medical advice. Do not take anti-diarrhoeal medicines without medical guidance.

Understanding acne vulgaris

Acne develops in the pilosebaceous units of the skin, structures comprising a hair follicle and its associated sebaceous (oil-producing) gland.

During puberty and beyond, androgens stimulate the sebaceous glands to produce increased amounts of sebum.

In acne-prone individuals, excess sebum combines with abnormal shedding of follicular keratinocytes to block the follicular opening, forming a microcomedone.

This provides an anaerobic, lipid-rich environment that favours the growth of Cutibacterium acnes, a Gram-positive anaerobic bacterium that is a normal resident of the skin flora but proliferates excessively in acne.

C. acnes triggers an inflammatory immune response through several mechanisms.

It activates toll-like receptors on keratinocytes and monocytes, stimulating the release of pro-inflammatory cytokines including interleukin-1, interleukin-8, interleukin-12, and tumour necrosis factor alpha.

This attracts neutrophils to the follicle, causing the redness, swelling, and pus formation characteristic of inflammatory acne lesions.

The resulting papules and pustules can progress to deeper nodules and cysts in severe cases, with a significant risk of permanent scarring.

Effective acne treatment targets one or more of the pathogenic factors: sebum production, follicular keratinisation, C. acnes colonisation, and inflammation. Duac addresses the bacterial and inflammatory components with a two-pronged approach.

How Duac works: mechanism of action

Duac gel contains two active ingredients with complementary mechanisms that together provide more effective acne treatment than either ingredient alone.

Clindamycin phosphate is a prodrug that is hydrolysed to active clindamycin in the skin.

Clindamycin is a lincosamide antibiotic that binds to the 50S ribosomal subunit of bacterial ribosomes, inhibiting the translocation step of protein synthesis.

When applied topically, it penetrates the follicular canal and reaches effective concentrations against C. acnes within the pilosebaceous unit. Clindamycin suppresses bacterial protein production, reducing the C.

acnes population and consequently the inflammatory mediators these bacteria trigger.

Clindamycin also has direct anti-inflammatory properties, inhibiting neutrophil chemotaxis and reducing the production of reactive oxygen species by inflammatory cells.

Benzoyl peroxide is a potent oxidising agent. On contact with skin, it decomposes to release reactive oxygen species (free radicals) that damage bacterial cell membranes, proteins, and DNA.

This provides rapid, broad-spectrum bactericidal activity against C. acnes and other skin organisms.

Crucially, benzoyl peroxide kills bacteria through a non-specific oxidative mechanism, meaning that bacterial resistance to benzoyl peroxide does not develop.

This is a critically important property in the context of rising global antibiotic resistance. Benzoyl peroxide also has mild comedolytic (pore-unblocking) and keratolytic (scale-dissolving) properties.

The rationale for combining clindamycin with benzoyl peroxide is twofold. First, the two agents provide additive or synergistic antibacterial efficacy, improving clinical outcomes compared with monotherapy.

Second, benzoyl peroxide prevents the emergence of clindamycin-resistant C. acnes strains, a problem well documented with topical clindamycin monotherapy.

Clinical guidelines, including those from NICE and the European Academy of Dermatology and Venereology, strongly recommend against using topical antibiotics for acne without a concurrent non-antibiotic antimicrobial such as benzoyl peroxide.

Clinical evidence and UK prescribing guidance

Randomised controlled trials have demonstrated that the combination of clindamycin 1% and benzoyl peroxide 5% produces significantly greater reductions in inflammatory and non-inflammatory acne lesion counts at 12 weeks compared with either clindamycin or benzoyl peroxide alone.

One pivotal study reported a mean reduction of approximately 65% in inflammatory lesions at 12 weeks with the combination, compared with approximately 45% with clindamycin alone and 40% with benzoyl peroxide alone.

NICE Clinical Knowledge Summaries (CKS) on acne vulgaris recommend topical treatments as first-line therapy for mild to moderate acne.

First-line topical options include a fixed-combination preparation of a topical antibiotic (such as clindamycin) with benzoyl peroxide, a topical retinoid, or benzoyl peroxide alone.

The combination of a topical antibiotic with benzoyl peroxide (as in Duac) is specifically endorsed as an effective and resistance-minimising first-line treatment.

NICE advises against using topical antibiotics as monotherapy (without benzoyl peroxide) due to resistance concerns.

The British Association of Dermatologists (BAD) guidelines on acne management similarly recommend combination topical therapy as first-line for mild to moderate inflammatory acne, with clindamycin/benzoyl peroxide and adapalene/benzoyl peroxide as preferred fixed-combination options.

How to use Duac gel

Wash the affected area with a mild, fragrance-free, non-medicated cleanser and pat dry.

Apply a thin, even layer of Duac gel to the entire affected area (not just individual spots) once daily, preferably in the evening.

Applying to the whole affected area treats developing microcomedones beneath the skin surface as well as visible lesions, helping prevent new spots from forming.

Allow the gel to dry before contact with clothing or bedding. Wash hands thoroughly after application. Avoid contact with the eyes, mouth, nostrils, and any broken or sunburned skin. If accidental contact with the eyes occurs, flush thoroughly with water.

A non-comedogenic, oil-free moisturiser can be applied after the gel has absorbed and dried to help manage dryness and peeling, which are common in the first few weeks.

In the morning, apply a non-comedogenic broad-spectrum sunscreen with SPF 30 or higher before going outdoors.

What to expect during treatment

During the first 1 to 2 weeks, you may notice increased dryness, peeling, and mild irritation as the skin adjusts to benzoyl peroxide.

This is normal and usually settles. Some patients experience a temporary initial worsening of acne (sometimes called purging) as existing microcomedones are brought to the surface.

This typically resolves within 2 to 4 weeks.

Improvement in inflammatory lesions (red spots, pustules) is usually noticeable from around week 4, with continued improvement through to week 12.

Comedones (blackheads and whiteheads) may take longer to clear.

If no meaningful improvement is seen after 12 weeks of consistent use, your prescriber should reassess and consider alternative or additional treatments.

Side effects of Duac gel

Common side effects

Local skin reactions are the most frequently reported side effects and include dryness, peeling, redness, burning or stinging on application, and itching.

These are generally mild to moderate, peak during the first 2 to 4 weeks, and improve with continued use. Using a non-comedogenic moisturiser helps manage these effects.

If irritation is excessive, your prescriber may advise reducing application to every other day initially.

Bleaching of fabrics and hair

Benzoyl peroxide will bleach coloured fabrics, hair, and furnishings on contact. This is a cosmetic inconvenience rather than a medical side effect, but patients should be prepared.

Use white or old pillowcases, towels, and clothing that may come into contact with the treated area. Allow the gel to dry completely before lying down or dressing.

Uncommon side effects

Contact dermatitis (allergic or irritant), photosensitivity reactions, and temporary worsening of acne are reported less commonly. Gastrointestinal symptoms (nausea, abdominal discomfort, diarrhoea) have been reported rarely, most likely due to minimal systemic absorption of clindamycin.

Rare but serious side effects

Antibiotic-associated colitis, including pseudomembranous colitis caused by Clostridioides difficile, has been reported with systemic clindamycin and very rarely with topical use.

If you develop persistent or bloody diarrhoea, abdominal cramps, or fever during or after using Duac, stop the gel immediately and seek urgent medical advice.

Do not take loperamide or other anti-diarrhoeal medicines, as these can worsen C. difficile disease. Severe allergic reactions (angioedema, anaphylaxis) are very rare.

When to seek medical advice

Contact your GP or pharmacist if local side effects are severe or persistent.

Seek urgent medical attention (call 999 or attend A&E) if you experience difficulty breathing, swelling of the face or throat, or severe diarrhoea with blood or mucus.

Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Antibiotic resistance

The inclusion of benzoyl peroxide in Duac significantly reduces the risk of clindamycin-resistant C. acnes compared with topical clindamycin alone. However, antibiotic stewardship remains important.

Do not use Duac for longer than 12 continuous weeks per course without medical review.

Do not use Duac alongside other topical antibiotics (such as erythromycin or fusidic acid) for acne, as this promotes cross-resistance.

If clindamycin resistance is suspected, alternative treatments should be considered.

Sun sensitivity

Benzoyl peroxide increases the skin's sensitivity to ultraviolet radiation. Apply a non-comedogenic sunscreen daily during treatment and avoid prolonged sun exposure and sunbeds. If a severe sunburn-like reaction occurs, discontinue Duac and consult your prescriber.

Clostridioides difficile risk

Although the risk of C. difficile-associated colitis from topical clindamycin is extremely low, it is a recognised possibility. The gel is contraindicated in patients with a history of antibiotic-associated colitis. Patients should be counselled to report any unexplained diarrhoea promptly.

Pregnancy and breastfeeding

There are no adequate studies of Duac in pregnant women. Benzoyl peroxide is not absorbed systemically in significant amounts. Clindamycin, when given systemically, crosses the placenta.

The topical route results in minimal systemic absorption, but the product should be used during pregnancy only if clearly needed and after discussion with the prescriber.

If used during breastfeeding, avoid applying the gel to the breast area.

Duac compared with other topical acne treatments

Several topical treatments are available for acne in the UK.

Benzoyl peroxide alone (available over the counter as Acnecide and other brands) is effective for mild acne and carries no risk of antibiotic resistance.

Adapalene (Differin), a topical retinoid, targets follicular keratinisation and is often used as an alternative or complement to antibacterial treatments.

The combination of adapalene with benzoyl peroxide (Epiduo) is another effective fixed-combination option. Topical clindamycin alone is not recommended due to the risk of resistance development.

Azelaic acid (Skinoren) is an alternative for mild to moderate acne and is safe in pregnancy.

For moderate to severe acne that does not respond to topical therapy, oral antibiotics (doxycycline, lymecycline) may be added alongside a topical non-antibiotic agent. Oral isotretinoin, prescribed by dermatologists, is reserved for severe, scarring, or treatment-resistant acne.

Living with acne: practical advice

Use a gentle, non-medicated, fragrance-free cleanser twice daily. Avoid harsh scrubbing, as this can worsen inflammation and damage the skin barrier.

Do not pick, squeeze, or pop spots, as this increases the risk of scarring and secondary infection. Use non-comedogenic, oil-free skincare and cosmetic products.

If acne is affecting your confidence or mental health, support is available through your GP, the NHS psychological therapies service (IAPT), and organisations such as the British Skin Foundation (britishskinfoundation.org.uk).

How to get a Duac prescription in the UK

Duac is a prescription-only medicine available through the NHS.

Your GP can prescribe it following an assessment of your acne type and severity, and a review of previous treatments tried.

If acne is severe, scarring, or has not responded to multiple topical and oral treatments, your GP may refer you to a dermatologist for specialist management.

Authorised online prescribers registered with the General Pharmaceutical Council (GPhC) may also prescribe Duac following a structured online consultation.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Sources

• Duac Once Daily Gel, Summary of Product Characteristics (EMC)
• Clindamycin with benzoyl peroxide, British National Formulary (BNF)
• NICE CKS: Acne vulgaris
• Acne, NHS
• British Association of Dermatologists, Acne
• MHRA Yellow Card Scheme