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To the Editor.—
In a large clinical practice, our experience with topical use of erythromycin in acne has been discouraging. Similar discouraging reports regarding topical application of tetracycline in acne turned our attention to two of the few remaining effective antibiotics, lincomycin hydrochloride monohydrate (Lincocin) and clindamycin (Cleocin).In topical form, clindamycin is becoming very popular among clinical dermatologists. For topical use, clindamycin in sterile solution for injection is diluted in appropriate vehicle and applied two to three times daily. Injectable clindamycin is in the phosphate form. Biological studies on clindamycin phosphate supplied by the manufacturer reveal that the phosphate form of this drug is inactive in vitro. Cleavage of the phosphate radical by phosphatases in the liver results in the active form of the drug. This argues against the effectiveness of injectable clindamycin phosphate used topically in the treatment of acne. Clindamycin hydrochloride hydrate (Cleocin Hydrochloride) solution, which