Acne Wars

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Many new combination Retin-A + antibiotic (either clindamycin or benzoyl peroxide) gels exist. They do kick butt against acne but there are a confusing number of gels to chose from. If you and your doctor have decided to use a Retin-A + antibiotic gel combination to fight your acne then it would help to know which one works best, at the most reasonable cost.

Topical retinoids cause drying, and the itchy, red, dry skin is the main reason people discontinue them. Well, which one causes the least amount of drying? We may be closer to knowing.

Ziana is a gel mixture of clindamycin and tretinoin (generic Retin-A) that was recently compared to Epiduo in a study, and it was found to be less irritating. Epiduo is a popular acne combination of benzoyl peroxide and adapalene (another retinoid).

What was reassuring was that both were pretty well tolerated—nevertheless Ziana does seem to be less irritating than Epiduo. The Epiduo group had more stinging, burning, and itching than the Ziana group. The great news is that both work, and there was no difference between the two topical agents in terms of reduction of acne lesion counts.

Ok, now the downsides. This study was funded by the makers of Ziana, just know that. Also, Ziana is expensive . . . really expensive. Veltin is the same combination as Ziana (clindamycin + .025% tretinoin) and it is cheaper. You can also talk to your doctor about using the generic clindamycin 1% gel + tretinoin .025% gel and mixing them, both are generic and that is much much cheaper.

Just sayin’

Dr O.

Ziana runs about $320 per 30 g tube, and $600+ for a 60 g tube, even with a coupon. The manufacturer does offer a discounted price of $35 for insured patients and $50 for cash-paying patients, but this is only good for three refills within the first six months—after that you’re on your own. The tier of insurance coverage varies quite a bit depending on the company and plan, but many do consider Ziana a Tier 2 or 3 drug, meaning a moderate to high copay.
Veltin is cheaper by almost half, about $190 per 30 g tube and $350 per 60 g tube.
In contrast, a 30 g tube of clindamycin 1% gel can be found for under $30 at several pharmacies, and is included in some pharmacy membership programs for as low as $12. A 15 g tube of tretinoin .025% gel costs about the same, under $30 at many pharmacies, and a 45 g tube may offer more savings (if your prescription allows) at anywhere from $40 – $60. Both are typically covered under the lowest copay Tier 1 by most insurance plans.

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