Management of acne vulgaris: an evidence-based update

Authors


  • Conflict of interest: none declared.

  • A more detailed analysis of all the new evidence published in the field of acne vulgaris between 2007 and 2009 can be found in the 20081 and 20092 Acne Vulgaris Annual Evidence Updates on the NHS Evidence – skin disorders (formerly the National Library for Health Skin Disorders Specialist Library) website, at http://www.library.nhs.uk/skin. Search methodologies, expert commentaries and links to the full original reports are included.

Dr John Ingram, Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK
E-mail: johningram@hotmail.co.uk

Summary

This review summarizes clinically important findings from 3 systematic reviews, 1 updated guideline and a selection from the 62 randomized controlled trials (RCTs) published between February 2007 and January 2009 on the topic of acne vulgaris. Low glycaemic-load diets might reduce acne severity but this remains unproven. Written patient information leaflets have not been surpassed by other communication methods. New combination topical treatments have not shown convincing advantages over current combination products such as clindamycin/benzoyl peroxide. Topical dapsone is superior to placebo but has yet to be compared with standard topical treatments. Long-term topical tretinoin to prevent nonmelanoma skin cancer in elderly men was associated with higher all-cause mortality, but there is currently no evidence of increased mortality for topical retinoid use when treating acne. All oral tetracyclines have similar efficacy, yet minocycline is the most costly. Oral isotretinoin monotherapy remains the gold-standard treatment for severe acne. Flutamide plus the oral contraceptive pill is beneficial for acne associated with polycystic ovary syndrome. Photodynamic therapy, phototherapy and laser therapy cannot be recommended universally for acne until minimal postinflammatory pigmentation and longer-term benefit can be shown, especially with current high costs. Development of non-antibiotic therapies is preferable to minimize the risk of community antibiotic resistance. Future trials should use active comparators at optimum doses and avoid noninferiority comparisons unless appropriately powered. Trials need to shift from using multiple, unvalidated outcome measures to including patient-reported and quality-of-life outcomes, and all trials should be registered on a public clinical-trials database.

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