NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Management options for mild to moderate acne – pairwise comparisons
Evidence review E2
NICE Guideline, No. 198
Authors
National Guideline Alliance (UK).Summary of review questions covered in this report
A single review protocol and literature search was used to identify randomised trials of treatments for acne vulgaris to address 9 review questions covering topical or oral pharmacological treatments and physical treatments, shown below. Outcomes were prioritised for either pairwise or network meta-analysis (NMA) and the evidence was divided according to the severity of acne into mild to moderate and moderate to severe categories. NMA was employed to assess comparative efficacy, acceptability and tolerability of treatments, which are outcomes commonly reported in the literature for the majority of treatments. Pairwise meta-analysis was used to synthesise outcomes for which evidence was more limited across treatments or was treatment-specific. The evidence was then summarised in four separate reviews covering the treatment of:
- mild to moderate acne (NMA)
- mild to moderate acne (pairwise meta-analysis)
- moderate to severe acne (NMA)
- moderate to severe acne (pairwise meta-analysis)
This evidence review contains information on the pairwise meta-analyses conducted to assess treatments for people with mild to moderate acne vulgaris. NMA has been the main method of analysis to inform these questions (see evidence review E1). This review reports the associated pairwise meta-analysis for outcomes not covered in the NMA. Information on the NMAs and pairwise meta-analyses conducted to assess treatments for people with moderate to severe acne vulgaris are contained in the evidence reports F1 and F2, respectively.
- What is the effectiveness of topical treatments individually or in combination in the treatment of acne vulgaris, for example:
- benzoyl peroxide
- antibiotics
- antiseptics
- retinoids and retinoid-like agents (for example, tretinoin, adapalene, trifarotene)
- azelaic acid
- nicotinamide
- combination of antibiotic and retinoid or retinoid-like agent
- combination of benzoyl peroxide and retinoid or retinoid-like agent
- combination of antibiotic and benzoyl peroxide?
- What is the effectiveness of oral antibiotic treatments individually or in combination in the treatment of acne vulgaris, for example:
- tetracyclines (for example oxytetracycline, doxycycline, minocycline, tetracycline, lymecycline)
- macrolide antibiotics (for example, erythromycin and azithromycin)
- trimethoprim?
- What is the effectiveness of an oral antibiotic with a topical agent compared to oral antibiotic alone in the treatment of acne vulgaris?
- What is the optimal duration of antibiotic treatments (topical and systemic) for acne vulgaris?
- What is the effectiveness of hormonal contraceptives in the treatment of acne vulgaris?
- What is the effectiveness of spironolactone in the treatment of acne vulgaris?
- What is the effectiveness of metformin in the treatment of acne vulgaris?
- What is the effectiveness of oral isotretinoin in the treatment of acne vulgaris?
- What is the effectiveness of physical treatments for acne vulgaris, for example
- comedone extraction
- chemical peels (for example, glycolic acid, lactic acid, salicylic acid)
- intralesional steroids
- light devices (for example, intense pulsed light, photopneumatic therapy and photodynamic therapy)?
Management options for mild to moderate acne – pairwise comparisons
Review question
What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne vulgaris (side effects and participant reported improvement)?
Introduction
Mild to moderate acne is very common with a wide range of treatment modalities available including over the counter products. Management options should be effective and acceptable to the individual, taking into consideration potential side effects and contraindications. This evidence review therefore aims to find the most effective treatment option for people with mild to moderate acne.
Summary of the protocol
Please see Table 1 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document (supplementary document 1).
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Clinical evidence
Included studies
Overall 62 studies were included in this pairwise review. These are divided into the following categories of interventions: topical non-retinoids and retinoids, own class topicals, topical antibiotics, topical antiseptics, topical acids, oral antibiotics and combinations with other topicals, oral hormonal contraceptives and hormone-modifying agents, oral isotretinoin and physical treatments.
Topical non-retinoids and retinoids
Eighteen parallel group design RCTs (Adhikary 2014, Babaeinejad 2013, Berger 2007a, Chalker 1987, Dubey 2016, Gollnick 2009, Guerra-Tapia 2012, Hughes 1992, Iftikhar 2009, Langner 2000, Marazzi 2002a, Shwetha 2014, Stinco 2007, Thiboutout 2006, Tirado-Sanchez 2013, Trifu 2011, Tu 2001, Webster 2001) reported side effects of topical retinoid treatments or topical treatment combinations including a retinoid treatment in people with mild to moderate acne. Skin irritation was reported by the vast majority of studies.
Four parallel group design RCTs (Babayeva 2011, Berger 2007a, Berger 2007b, Marazzi 2002a) mentioned participants reported improvement of acne.
Four studies were conducted in the USA (Berger 2007a, Berger 2007b, Chalker 1987, Webster 2001), 3 studies in India (Adhikary 2014, Dubey 2016, Shwetha 2014), 2 studies in the UK (Hughes 1992, Marazzi 2002a), 1 study in China (Tu 2001), Italy (Stinco 2007), Iran (Babaeinejad 2013), Pakistan (Iftikhar 2009), Poland (Langner 2000), Mexico (Tirado-Sanchez 2013), Romania (Trifu 2011), Spain (Guerra-Tapia 2012), Turkey (Babayeva 2011); 2 studies were collaborations studies from North America/Europe (Gollnick 2009) and North America (Thiboutout 2006).
Own class topicals
Four parallel group design RCTs (Charakida 2007, Hanstead 1985, Katsambas 1989, Pazoki-Toroudi 2010) reported skin irritation as a side effect of treatment with Acnicare, topical azelaic acid and topical fucidic acid.
One study was conducted in Denmark (Hanstead 1985), Greece (Katsambas 1989), Iran (Pazoki-Toroudi 2010) and the UK (Charakida 2007).
Topical antibiotics
Fourteen parallel group design RCTs (Alirezai 2005, Carey 1996, Cunliffe 2002b, Eichenfield 2016, Hajheydari 2011, Jain 1998, Khanna 1990, Leyden 1987, Pazoki-Toroudi 2010, Pazoki-Toroudi 2011, Schaller 2016, Shalita 2005, Stein Gold 2016, Xu 2016) reported skin irritation as a side effect of treatment with topical antibiotics. Carey 1996 and Pazoki-Toroudi 2010 also mentioned participant reported improvement of acne.
Three studies were conducted in Iran (Hajheydari 2011, Pazoki-Toroudi 2010, Pazoki-Toroudi 2011) and the USA (Leyden 1987, Shalita 2005, Stein Gold 2016), 2 studies in India (Jain 1998, Khanna 1990), 1 study in Canada (Carey 1996), China (Xu 2016), Germany (Schaller 2016) and the UK (Cunliffe 2002b); 2 studies were collaboration studies from Europe (Alirezai 2005) and North America (Eichenfield 2016).
Topical antiseptics
Five parallel group design RCTs (Gollnick 2009, Hughes 1992, Milani 2003, Smith 1980b, Stoughton 1987) reported skin irritation as a side effects of treatment with topical antiseptics in people with mild to moderate acne.
Two studies were conducted in the USA (Smith 1980b-USA, Stoughton 1987), 1 in Italy (Milani 2003) and in the UK (Hughes 1992); 1 study was a collaboration study from Europe/North America (Gollnick 2009).
Topical acids
One parallel group design RCT (Boutli 2003) reported skin irritation and light sensitivity as side effects of treatment with topical acids. Three parallel group RCTs (Akarsu 2012, Poli 2005, Shalita 1981) mentioned participant reported improvement of acne.
One study was conducted in Greece (Boutli 2003), France (Poli 2005), Turkey (Akarsu 2012) and the USA (Shalita 1981).
Oral antibiotics and combinations with other topicals
Four parallel group design RCTs (Bleeker 1983, Maleszka 2011, Ozolins 2004, Rassai 2013) reported side effects of treatment with oral antibiotics or oral antibiotics in combination with topical antibiotics in people with mild to moderate acne. Ozolins 2004 and Rassai 2013 also mentioned participant reported improvement of acne.
One study was conducted in Iran (Rassai 2013), Poland (Maleszka 2011), Sweden (Bleeker 1983) and the UK (Ozolins 2004).
Oral hormonal contraceptives and hormone-modifying agents
Seven parallel group design RCTs (Alora Palli 2013, Jaisamrarn 2014, Jaisamrarn 2018, Leyden 2002, Palombo-Kinne 2009, Plewig 2009, Thorneycroft 2004) reported side effects of treatment with oral hormonal contraceptives and hormone-modifying agents in women with mild to moderate acne. Most often reported side effects were breast tenderness, breakthrough bleeding and neurological side effects. Plewig 2009 also mentioned participant reported improvement of acne.
Two studies were conducted in the USA (Alora Palli 2013, Leyden 2002), 2 studies in Thailand (Jaisamrarn 2014, Jaisamrarn 2018) and 1 study in Germany (Thorneycroft 2004); 2 studies were collaboration studies from Europe (Palombo-Kinne 2009-Europe, Plewig 2009).
Oral isotretinoin
One parallel group design RCT (Rademaker 2014, New Zealand) reported mucosal/cutaneous changes as a side effect of treatment with oral isotretinoin in people with mild to moderate acne.
Physical treatments
Chemical peels
Three parallel group design RCT (Dayal 2017, Dayal 2020, Sarkar 2019) reported side effects of treatments with chemical peels in people with mild to moderate acne. The most often reported side effects were erythema and changes in pigmentation. All 3 studies were conducted in India.
Energy based treatments (light/laser)
Three parallel group design RCTs (Papageorgiou 2000a, Ragab 2014, Seaton 2003) reported side effects of energy based treatments in people with mild to moderate acne. Most often reported side effects were skin irritation and erythema. Ragab 2014 also mentioned participant reported improvement of acne.
Two studies were conducted in the UK (Papageorgiou 2000a, Seaton 2003) and 1 study in Egypt (Ragab 2014).
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review with reasons for their exclusion are provided in appendix K.
Summary of included studies
Summaries of the studies that were included in this review are presented in Table 2. The evidence table in appendix D lists all relevant outcomes including those extracted for the network meta-analysis (clinician reported improvement, discontinuation due for any reason and discontinuation due to adverse events). Only the relevant outcomes for the pairwise analysis are listed below.
See the full evidence tables in appendix D and the forest plots in appendix E.
Quality assessment of included studies in the evidence review
See the evidence profiles in appendix F.
Economic evidence
Included studies
A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in appendix B and economic study selection flow chart in appendix G.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Economic model
The economic model associated with these review questions was based on the NMA results (see evidence report E1).
The committee’s discussion of the evidence
The pairwise analysis was supplementary to the network meta-analysis so evidence from both of these were discussed when recommendations were drafted. For the discussion of the evidence that supported the recommendations see evidence report E1.
Recommendations supported by this evidence review
Evidence review underpinning recommendations 1.5.1, 1.5.2 and 1.5.5 to 1.5.14 (excluding 1.5.6 which is underpinned by evidence report L, 1.5.10 and bullet points 2 and 3 of recommendation 1.5.12 which are underpinned by evidence report F1) and 3 research recommendations on the effectiveness of chemical peels, the effectiveness of physical modalities and the effectiveness of hormone-modifying agents. Other evidence supporting these recommendations as well as the committee’s discussion of the evidence can be found in the evidence review on mild to moderate acne network meta-analysis (evidence report E1).
References
Adhikary 2014
Adhikary, J.Satyanarayana, V., Bhandare, B., Vivekananda. A comparative study to evaluate the efficacy and safety of topical isotretinoin and clindamycin versus adapalene and clindamycin in the treatment of grade I - II acne vulgaris of face. International Journal of Pharmaceutical Sciences Review and Research2014, 29(1):175–9Akarsu 2012
Akarsu, S.Emel, F., Yücel, F., Gül, E., Günes, A. T.Efficacy of the addition of salicylic acid to clindamycin and benzoyl peroxide combination for acne vulgaris. Journal of Dermatology2012, 39(5):433–8 [PubMed: 22035285]Alirezai 2005
Alirezai, M., Gerlach, B., Horvath, A., Forsea, D.Briantais, P., Guyomar, M.Results of a randomised, multicentre study comparing a new water-based gel of clindamycin 1% versus clindamycin 1% topical solution in the treatment of acne vulgaris. European Journal of Dermatology, 2005, 15(4):274–8 [PubMed: 16048758]Alora Palli 2013
Alora Palli, M. B., Reyes-Habito, C. M., Lima, X. T., Kimball, A. B.A single-center, randomized double-blind, parallel-group study to examine the safety and efficacy of 3mg drospirenone/0.02mg ethinyl estradiol compared with placebo in the treatment of moderate truncal acne vulgaris. Journal of Drugs in Dermatology, 2013, 12(6):633–7 [PubMed: 23839178]Babaeinejad 2013
Babaeinejad, S. H., Fouladi, R. F.The efficacy, safety, and tolerability of adapalene versus benzoyl peroxide in the treatment of mild acne vulgaris: a randomized trial. Journal of Drugs in Dermatology, 2013, 12(7):790–4 [PubMed: 23884492]Babayeva 2011
Babayeva, L.Akarsu, S., Fetil, E., Gunes, A. T.Comparison of tretinoin 0.05% cream and 3% alcohol-based salicylic acid preparation in the treatment of acne vulgaris. Journal of the European Academy of Dermatology and Venereology, 2011, 25(3):328–3 [PubMed: 20666879]Berger 2007a
Berger, R.Barba, A., Fleischer, A., Leyden, J. J., Lucky, A., Pariser, D., Rafal, E., Thiboutot, D., Wilson, D., Grossman, R., et al. A double-blinded, randomized, vehicle-controlled, multicenter, parallel-group study to assess the safety and efficacy of tretinoin gel microsphere 0.04% in the treatment of acne vulgaris in adults. Cutis, 2007, 80(2):152–7 [PubMed: 17944177]Berger 2007b
Berger, R., Rizer, R., Barba, A., Wilson, D., Stewart, D., Grossman, R., Nighland, M., Weiss, J.Tretinoin gel microspheres 0.04% versus 0.1% in adolescents and adults with mild to moderate acne vulgaris: a 12-week, multicenter, randomized, double-blind, parallel-group, phase IV trial. Clinical Therapeutics, 2007, 29(6):1086–97 [PubMed: 17692723]Bleeker 1983
Bleeker, J.Tolerance and efficacy of erythromycin stearate tablets versus enteric-coated erythromycin base capsules in the treatment of patients with acne vulgaris. Journal of International Medical Research, 1983, 11(1):38–41 [PubMed: 6219902]Boutli 2003
Boutli, F., Zioga, M., Koussidou, T., Ioannides, D., Mourellou, O.Comparison of chloroxylenol 0.5% plus salicylic acid 2% cream and benzoyl peroxide 5% gel in the treatment of acne vulgaris: a randomized double-blind study. Drugs Under Experimental and Clinical Research, 2003, 29(3):101–5 [PubMed: 14708455]Carey 1996
Carey, W., Bakbo, J. C.A Canadian multicentre study to compare fusidic acid lotion and erythromycin solution in the treatment of acne vulgaris of the face. European Journal of Clinical Research, 1996, 8:171–81Chalker 1987
Chalker, D. K., Lesher, J. L.Jr, Smith, J. G., Klauda, H. C., Pochi, P. E., Jacoby, W. S., Yonkosky, D. M., Voorhees, J. J., Ellis, C. N., Matsuda-John, S., et al. Efficacy of topical isotretinoin 0.05% gel in acne vulgaris: results of a multicenter, double-blind investigation. Journal of the American Academy of Dermatology, 1987, 17(2 Pt 1):251–4 [PubMed: 2957398]Charakida 2007
Charakida, A., Charakida, M., Chu, A. C.Double-blind, randomized, placebo-controlled study of a lotion containing triethyl citrate and ethyl linoleate in the treatment of acne vulgaris. British Journal of Dermatology, 2007, 157(3):569–74 [PubMed: 17635508]Cunliffe 2002b
Cunliffe, W. J., Holland, K. T., Bojar, R., Levy, S. F.A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris. Clinical Therapeutics, 2002, 24(7):1117–33 [PubMed: 12182256]Dayal 2017
Dayal, S., Amrani, A., Sahu, P., Jain, V. K.Jessner’s solution vs. 30% salicylic acid peels: a comparative study of the efficacy and safety in mild-to-moderate acne vulgaris. Journal of Cosmetic Dermatology, 2017, 16(1):43–51 [PubMed: 27557589]Dayal 2020
Dayal, S., Kalra, K. D., Sahu, P.Comparative study of efficacy and safety of 45% mandelic acid versus 30% salicylic acid peels in mild-to-moderate acne vulgaris. Journal of Cosmetic Dermatology, 2020, 19(2):393–9 [PubMed: 31553119]Dubey 2016
Dubey, A., Amane, H.Comparison of efficacy and safety of adapalene and benzoyl peroxide-clindamycin combination in the topical treatment of acne vulgaris. International Journal of Basic and Clinical Pharmacology, 2016, 5(5):1727–32Eichenfield 2016
Eichenfield, L. F., Lain, T., Frankel, E. H., Jones, T. M., Chang-Lin, J. E., Berk, D. R., Ruan, S., Kaoukhov, A.Efficacy and safety of once-daily dapsone gel, 7.5% for treatment of adolescents and adults with acne vulgaris: Second of two identically designed, large, multicenter, randomized, vehicle-controlled trials. Journal of Drugs in Dermatology, 2016, 15(8):962–9 [PubMed: 27537997]Gollnick 2009
Gollnick, H. P. M., Draelos, Z., Glenn, M. J., Rosoph, L. A., Kaszuba, A., Cornelison, R., Gore, B., Liu, Y.Graeber, M. Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. British Journal of Dermatology, 2009, 161(5):1180–9 [PubMed: 19466959]Guerra-Tapia 2012
Guerra-Tapia, A.Effects of benzoyl peroxide 5% clindamycin combination gel versus adapalene 0.1% on quality of life in patients with mild to moderate acne vulgaris: A randomized single-blind study. Journal of Drugs in Dermatology, 2012, 11(6):714–22 [PubMed: 22648218]Hajheydari 2011
Hajheydari, Z., Mahmoudi, M., Vahidshahi, K., Nozari, A.Comparison of efficacy of Azithromycin vs. Clindamycin and erythromycin in the treatment of mild to moderate acne vulgaris. Pakistan Journal of Medical Sciences, 2011, 27(1):68–72Hansted 1985
Hansted, B., Jorgensen, J., Reymann, F., Christiansen, J.Fucidin cream for topical treatment of acne vulgaris. Current Therapeutic Research, Clinical and Experimental, 1985, 37:249–53Hughes 1992
Hughes, B. R., Norris, J. F., Cunliffe, W. J.A double-blind evaluation of topical isotretinoin 0.05%, benzoyl peroxide gel 5% and placebo in patients with acne. Clinical and Experimental Dermatology, 1992, 17(3):165–8 [PubMed: 1451291]Iftikhar 2009
Iftikhar, U., Aman, S., Nadeem, M., Kazmi, A. H.A comparison of efficacy and safety of topical 0.1% adapalene and 4% benzoyl peroxide in the treatment of mild to moderate acne vulgaris. Journal of Pakistan Association of Dermatologists2009, 19:141–145Jain 1998
Jain, V. K., Chopra, K. L., Dayal, S.Comparative evaluation of topical benzoyl peroxide, metronidazole and benzoyl peroxide - clindamycin combination in treatment of acne vulgaris. Indian Journal of Dermatology, Venerology and Leprology, 1998, 64(2):71–4 [PubMed: 20921719]Jaisamrarn 2014
Jaisamrarn, U., Chaovisitsaree, S., Angsuwathana, S., Nerapusee, O.A comparison of multiphasic oral contraceptives containing norgestimate or desogestrel in acne treatment: A randomized trial. Contraception, 2014, 90(5):535–41. [PubMed: 25074072]Jaisamrarn 2018
Jaisamrarn, U., Santibenchakul, S.A comparison of combined oral contraceptives containing chlormadinone acetate versus drospirenone for the treatment of acne and dysmenorrhea: a randomized trial. Contraception & Reproductive Medicine, 2018, 10(3):5 [PMC free article: PMC5891982] [PubMed: 29662684]Katsambas 1989; Trial 1
Katsambas, A., Graupe, K., Stratigos, J.Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin. Acta Dermato-Venereologica, Supplementum, 1989, 143:35–9 [PubMed: 2528257]Khanna 1990
Khanna, N.Topical clindamycin hydrochloride 1% in acne vulgaris. Indian Journal of Dermatology, Venerology and Leprology, 1990, 56(5):377–80Langner 2000
Langner, A., Stapor, W., Donald, A. E., Boorman, G. C.Double-blind, placebo-controlled study of the efficacy and safety of isotretinoin cream (0.05% w/w and 0.10% w/w) with sunscreens in the treatment of mild to moderate acne vulgaris. Journal of Dermatological Treatment, 2000, 11(1):7–14Leyden 1987
Leyden, J. J., Shalita, A. R., Saatjian, G. D., Sefton, J.Erythromycin 2% gel in comparison with clindamycin phosphate 1% solution in acne vulgaris. Journal of the American Academy of Dermatology, 1987, 16(4):822–7 [PubMed: 2952685]Leyden 2002
Leyden, J. J., Tanghetti, E. A., Miller, B., Ung, M., Berson, D., Lee, J.Once-daily tazarotene 0.1 % gel versus once-daily tretinoin 0.1 % microsponge gel for the treatment of facial acne vulgaris: a double-blind randomized trial. Cutis, 2002, 69(2 Suppl):12–9 [PubMed: 12095064]Maleszka 2011
Maleszka, R., Turek-Urasinska, K., Oremus, M., Vukovic, J., Barsic, B.Pulsed azithromycin treatment is as effective and safe as 2-week longer daily doxycycline treatment of acne vulgaris: a randomized, double-blind, noninferiority study. Skinmed, 2011, 9(2):86–94. [PubMed: 21548512]Marazzi 2002a
Marazzi, P., Boorman, G.C., Donald, A.E., Davies, H.D.Clinical evaluation of Double Strength Isotrexin versus Benzamycin in the topical treatment of mild to moderate acne vulgaris. Journal of Dermatological Treatment, 2002, 13(3):111–7 [PubMed: 12227873]Milani 2003
Milani, M., Bigardi, A., Zavattarelli, M.Efficacy and safety of stabilised hydrogen peroxide cream (Crystacide) in mild-to-moderate acne vulgaris: A randomised, controlled trial versus benzoyl peroxide gel. Current Medical Research and Opinion, 2003, 19(2):135–8 [PubMed: 12740158]Ozolins 2004
Ozolins, M., Eady, E. A., Avery, A. J., Cunliffe, W. J., Wan Po, A. L., O’Neill, C., Simpson, N. B., Walters, C. E., Carnegie, E., Lewis, J. B., Dada, J., Haynes, M., Williams, K., Williams, H. C.Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet, 2004, 364(9452):2188–95 [PubMed: 15610805]Palombo-Kinne 2009
Palombo-Kinne, E., Schellschmidt, I., Schumacher, U., Graser, T.Efficacy of a combined oral contraceptive containing 0.030 mg ethinylestradiol/2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/2 mg cyproterone acetate. Contraception, 2009, 79(4):282–9 [PubMed: 19272497]Papageorgiou 2000a
Papageorgiou, P., Katsambas, A., Chu, A.Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. British Journal of Dermatology, 2000, 142(5):973–8 [PubMed: 10809858]Pazoki-Toroudi 2010
Pazoki-Toroudi, H., Nassiri-Kashani, M., Tabatabaie, H., Ajami, M., Habibey, R., Shizarpour, M., Babakoohi, S., Rahshenas, M., Firooz, A.Combination of azelaic acid 5% and erythromycin 2% in the treatment of acne vulgaris. Journal of Dermatological Treatment, 2010, 21(3):212–6 [PubMed: 20394495]Pazoki-Toroudi 2011
Pazoki-Toroudi, H., Nilforoushzadeh, M. A., Ajami, M., Jaffary, F., Aboutaleb, N., Nassiri-Kashani, M., Firooz, A.Combination of azelaic acid 5% and clindamycin 2% for the treatment of acne vulgaris. Cutaneous and Ocular Toxicology, 2011, 30(4):286–91 [PubMed: 21612319]Plewig 2009
Plewig, G., Cunliffe, W. J., Binder, N., Hoschen, K.Efficacy of an oral contraceptive containing EE 0.03 mg and CMA 2 mg (Belara) in moderate acne resolution: a randomized, double-blind, placebo-controlled Phase III trial. Contraception, 2009, 80(1):25–33 [PubMed: 19501212]Poli 2005
Poli, F., Ribet, V., Lauze, C., Adhoute, H., Morinet, P.Efficacy and safety of 0.1% retinaldehyde/ 6% glycolic acid (diacneal) for mild to moderate acne vulgaris. A multicentre, double-blind, randomized, vehicle-controlled trial. Dermatology (Basel, Switzerland), 2005, 210 Suppl 1:14–21 [PubMed: 15724103]Rademaker 2014
Rademaker, M., Wishart, J. M., Birchall, N. M.Isotretinoin 5 mg daily for low-grade adult acne vulgaris - A placebo-controlled, randomized double-blind study. Journal of the European Academy of Dermatology and Venereology, 2014, 28(6):747–54 [PubMed: 23617693]Ragab 2014
Ragab, M., Hussein, T., Salem, M.Photodynamic therapy using 5-aminolevulinic acid and intense pulsed light against intense pulsed light alone in the treatment of acne vulgaris. Journal of the Egyptian Women’s Dermatologic Society, 2014, 11(3):173–180Rassai 2013
Rassai, S., Mehri, M., Yaghoobi, R., Sina, N., Mohebbipour, A., Feily, A.Superior efficacy of azithromycin and levamisole vs. azithromycin in the treatment of inflammatory acne vulgaris: An investigator-blind randomized clinical trial in 169 patients. International Journal of Clinical Pharmacology and Therapeutics, 2013, 51(6):490–4 [PubMed: 23547851]Sarkar 2019
Sarkar, R., Ghunawat, S., Garg, V. K.Comparative Study of 35% Glycolic Acid, 20% Salicylic-10% Mandelic Acid, and Phytic Acid Combination Peels in the Treatment of Active Acne and Postacne Pigmentation. Journal of Cutaneous and Aesthetic Surgery, 2019, 12(3):158–163 [PMC free article: PMC6785964] [PubMed: 31619887]Schaller 2016
Schaller, M., Sebastian, M., Rees, C., Seidel, D., Hennig, M.A multicentre, randomized, single-blind, parallel-group study comparing the efficacy and tolerability of benzoyl peroxide 3%/clindamycin 1% with azelaic acid 20% in the topical treatment of mild-to-moderate acne vulgaris. Journal of the European Academy of Dermatology and Venereology,2016, 30(6):966–73 [PubMed: 26915831]Seaton 2003
Seaton, E. D., Charakida, A., Mouser, P. E., Grace, I., Clement, R. M., Chu, A. C.Pulsed-dye laser treatment for inflammatory acne vulgaris: randomised controlled trial. Lancet, 2003, 362(9393):1347–52 [PubMed: 14585635]Shalita 1981
Shalita, A. R.Treatment of mild and moderate acne vulgaris with salicylic acid in an alcohol detergent vehicle. Cutis, 1981, 28(5):556–8 [PubMed: 6458457]Shalita 2005
Shalita, A., Miller, B., Menter, A., Abramovits, W., Loven, K., Kakita, L.Tazarotene cream versus adapalene cream in the treatment of facial acne vulgaris: a multicenter, double-blind, randomized, parallel-group study. Journal of Drugs in Dermatology, 2005, 4(2):153–8 [PubMed: 15776771]Shwetha 2014
Shwetha, H., Geetha, A., Revathi, T. N.A comparative study of efficacy and safety of combination of topical 1% clindamycin and 0.1% adapalene with 1% clindamycin and 2.5% benzoyl peroxide in mild to moderate acne at a tertiary care hospital. Journal of Chemical and Pharmaceutical Research, 2014, 6(2):736–41Smith 1980b
Smith, E. B., Padilla, R. S., McCabe, J. M., Becker, L. E.Benzoyl peroxide lotion (20 percent) in acne. Cutis, 1980, 25(1):90–2 [PubMed: 6444379]Stein Gold 2016
Stein Gold, L. F., Jarratt, M. T., Bucko, A. D., Grekin, S. K., Berlin, J. M., Bukhalo, M., Weiss, J. S., Berk, D. R., Chang-Lin, J. E., Lin, V., et al. Efficacy and Safety of Once-Daily Dapsone Gel, 7.5% for Treatment of Adolescents and Adults with Acne Vulgaris: first of Two Identically Designed, Large, Multicenter, Randomized, Vehicle-controlled Trials. Journal of Drugs in Dermatology, 2016, 15(5):553–61 [PubMed: 27168264]Stinco 2007
Stinco, G., Bragadin, G., Trotter, D., Pillon, B., Patrone, P.Relationship between sebostatic activity, tolerability and efficacy of three topical drugs to treat mild to moderate acne. Journal of the European Academy of Dermatology and Venereology, 2007, 21(3):320–5 [PubMed: 17309452]Stoughton 1987
Stoughton, R. B., Leyden, J. J.Efficacy of 4 percent chlorhexidine gluconate skin cleanser in the treatment of acne vulgaris. Cutis, 1987, 39(6):551–3 [PubMed: 2956067]Thiboutot 2006
Thiboutot, D., Pariser, D. M., Egan, N., Flores, J., HerndonJ. H.Jr, Kanof, N. B., Kempers, S. E., Maddin, S., Poulin, Y. P., Wilson, D. C., Hwa, J., Liu, Y., Graeber, M.Adapalene Study Group. Adapalene gel 0.3% for the treatment of acne vulgaris: a multicenter, randomized, double-blind, controlled, phase III trial. Journal of the American Academy of Dermatolology, 2006, 54(2):242–50 [PubMed: 16443054]Thorneycroft 2004
Thorneycroft, I. H., Gollnick, H., Schellschmidt, I.Superiority of a combined contraceptive containing drospirenone to a triphasic preparation containing norgestimate in acne treatment. Cutis, 2004, 74(2):123–30 [PubMed: 15379365]Tirado-Sanchez 2013
Tirado-Sanchez, A., Espindola, Y. S., Ponce-Olivera, R. M., Bonifaz, A.Efficacy and safety of adapalene gel 0.1% and 0.3% and tretinoin gel 0.05% for acne vulgaris: Results of a single-center, randomized, double-blinded, placebo-controlled clinical trial on Mexican patients (skin type III-IV). Journal of Cosmetic Dermatology, 2013, 12(2):103–7 [PubMed: 23725303]Trifu 2011
Trifu, V.Tiplica, G. S., Naumescu, E., Zalupca, L., Moro, L., Celasco, G.Cortexolone 17alpha-propionate 1% cream, a new potent antiandrogen for topical treatment of acne vulgaris. A pilot randomized, double-blind comparative study vs. placebo and tretinoin 0.05% cream. British Journal of Dermatology, 2011, 165(1):177–83 [PubMed: 21428978]Tu 2001
Tu, P.Li, G. Q., Zhu, X. J., Zheng, J., Wong, W. Z.A comparison of adapalene gel 0.1% vs. tretinoin gel 0.025% in the treatment of acne vulgaris in China. Journal of the European Academy of Dermatology and Venereology, 2001, 15 Suppl 3:31–6 [PubMed: 11843231]Webster 2001
Webster, G. F., Berson, D., Stein, L. F., Fivenson, D. P., Tanghetti, E. A., Ling, M.Efficacy and tolerability of once-daily tazarotene 0.1% gel versus once-daily tretinoin 0.025% gel in the treatment of facial acne vulgaris: a randomized trial. Cutis, 2001, 67(6 Suppl):4–9 [PubMed: 11499329]Xu 2016
Xu, J. H., Lu, Q. J., Huang, J. H., Hao, F., Sun, Q. N., Fang, H., Gu, J., Dong, X. Q., Zheng, J., Luo, D., et al. A multicentre, randomized, single-blind comparison of topical clindamycin 1%/benzoyl peroxide 5% once-daily gel versus clindamycin 1% twice-daily gel in the treatment of mild to moderate acne vulgaris in Chinese patients. Journal of the european academy of dermatology and venereology, 2016, 30(7):1176–82 [PubMed: 27075705]
Appendices
Appendix A. Review protocol
Appendix B. Literature search strategies
Appendix C. Clinical evidence study selection
Appendix D. Evidence tables
Appendix E. Forest plots
Appendix F. GRADE tables
Appendix G. Economic evidence study selection
Appendix H. Economic evidence tables
Economic evidence tables for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)?
No economic evidence was identified which was applicable to this review question.
Appendix I. Economic evidence profiles
Economic model for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)?
The economic model associated with this review question was based on the NMA results. So for the economic evidence profile see evidence report E1.
Appendix J. Economic analysis
Economic analysis for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)?
The economic model associated with this review question was based on the NMA results. So for the economic analysis see evidence report E1.
Appendix K. Excluded studies
Excluded clinical and economic studies for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)?
Clinical studies
Download PDF (1.5M)
Economic studies and studies reporting utility data
Download PDF (195K)
Appendix L. Research recommendations
Research recommendations for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)?
For research recommendations associated with this review question see appendix L in evidence report E1.
Tables
Table 1Summary of the protocol
| Population | People with acne vulgaris, of all ages who have mild to moderate acne |
|---|---|
| Intervention |
Interventions will be categorised into the following classes (and, if relevant, subclasses): ➢ TOPICAL TREATMENTS Abrasive/cleaning agents
➢ ORAL HORMONAL CONTRACEPTIVES AND HORMONE-MODIFYING AGENTS
|
| Comparison |
|
| Outcomes |
Important
|
Table 2Summary of included studies
| Study | Population | Interventions | Outcomes |
|---|---|---|---|
|
Country: India Study type: RCT |
N=200 Sex: mixed Number randomised: arm 1: n=100 Number randomised: arm 2: n=100 Inclusion details: Age at least 10 years, grade I to grade II acne vulgaris of face, on the Indian grading scale. |
Intervention: arm 1: topical Isotretinoin gel 0.05 % once daily at night and topical Clindamycin phosphate 1% lotion in the morning Intervention: arm 2: Adapalene 0.1 % gel once daily at night and topical Clindamycin phosphate 1% lotion in the morning. |
|
|
Country: Turkey Study type: RCT |
N=50 Sex: mixed Number randomised: arm 1: n=25 Number randomised: arm 2: n=25 Inclusion details: Mild to moderate AV, between the ages of 18 and 35 years, and with between 10–50 IL and 10–100 NIL above the mandibular line at baseline. |
Intervention: arm 1: SAL 3% + CLIND-topical 1% + BPO-topical 5% Intervention: arm 2: CLIND-topical 1% + BPO-topical 5% |
|
|
Country: Europe Study type: RCT |
N=592 Sex: mixed Number randomised: arm 1: n=265 Number randomised: arm 2: n=261 Number randomised: arm 3: n=66 Inclusion details: At least age 12, acne vulgaris on face (severity grade of 2 to 5 on the Leeds revised scale), and 15–50 inflammatory facial lesions. |
Intervention: arm 1: CLIND-topical 1% gel Intervention: arm 2: CLIND-topical 1% topical solution Intervention: arm 3: Vehicle gel |
|
|
Country: United States Study type: RCT |
N=30 Sex: female Number randomised: arm 1: n=16 Number randomised: arm 2: n=14 Inclusion details: Female, age 18 to 45 years, who achieved spontaneous menarche, desired contraception and had a diagnosis of truncal acne of 10 to 50 inflammatory lesions on the back and chest combined with not more than 5 nodules. |
Intervention: arm 1: EE-oral 0.02 mg + DROS-oral 3mg od Intervention: arm 2: PLC-oral |
|
|
Country: Iran Study type: RCT |
N=60 Sex: mixed Number randomised: arm 1: n=30 Number randomised: arm 2: n=30 Inclusion details: Mild acne vulgaris (Evaluator Global Severity Score, EGSS, of 2). |
Intervention: arm 1: BPO 2.5% gel Intervention: arm 2: ADAP 0.1% gel |
|
|
Country: Turkey Study type: RCT |
N=46 Sex: mixed Number randomised: arm 1: n=23 Number randomised: arm 2: n=23 Inclusion details: 18 and 35 years of age, with 10–50 inflammatory lesions and 10–100 non-Inflammatory lesions above the mandibular line at baseline. |
Intervention: arm 1: SAL 3% + CLIND-topical 1% Intervention: arm 2: TRET-topical 0.05% + CLIND-topical 1% |
|
|
Country: United States Study type: RCT |
N=156 Sex: mixed Number randomised: arm 1: n=78 Number randomised: arm 2: n=78 Inclusion details: Ages 12 to 40 years, in good health, with mild to moderate acne vulgaris defined as 20 to 150 total facial lesions. Of these lesions, 10 to 100 were to be comedones (open and closed), and 10 to 50 were to be inflammatory lesions (papules and pustules). No more than 2 were to be nodules (defined as deep inflammatory lesions of 1 cm or greater). |
Intervention: arm 1: TRET-topical 0.04% Intervention: arm 2: TRET-topical 0.1% |
|
|
Country: United States Study type: RCT |
N=178 Sex: mixed Number randomised: arm 1: n=88 Number randomised: arm 2: n=90 Inclusion details: 19 and 45 years of age with mild to moderate acne vulgaris - between 15 and 80 total facial lesions that consisted of 10 to 40 inflammatory lesions and no more than 2 nodules. |
Intervention: arm 1: TRET-topical 0.04% Intervention: arm 2: Vehicle gel |
|
|
Country: Sweden Study type: RCT |
N=40 Sex: mixed Number randomised: arm 1: n=20 Number randomised: arm 2: n=20 Inclusion details: Mild to moderate papulopustular acne. |
Intervention: arm 1: Erythromycin stearate capsules 500mg b.d. Intervention: arm 2: Erythromycin base capsules 500mg b.d. |
|
|
Country: Greece Study type: RCT |
N=37 Sex: mixed Number randomised: arm 1: n=19 Number randomised: arm 2: n=18 Inclusion details: Age 13–25, moderate acne (grade 11, Pilsbury and Kligman), 20–50 comedones and 20–40 papulopustules. |
Intervention: arm 1: Topical benzoil peroxide 5% gel Intervention: arm 2: Topical Nisal cream (chloroxylenol 0.5% + salicylic acid 2%) |
|
|
Country: Canada Study type: RCT |
N=499 Sex: mixed Number randomised: arm 1: n=249 Number randomised: arm 2: n=250 Inclusion details: Under 25 years, 15 - 75 inflamed lesions on the face. |
Intervention: arm 1: Topical fucidic acid 2% Intervention: arm 2: Topical erythromycin 2% |
|
|
Country: United States Study type: RCT |
N=313 Sex: mixed Number randomised: arm 1: n=156 Number randomised: arm 2: n=157 Inclusion details: Acne vulgaris with a minimum of 12 inflammatory lesions and 12 noninflammatory lesions and a maximum of 3 facial nodulocystic lesions, aged 13–30. |
Intervention: arm 1: Topical ISO 0.05% gel b.d. Intervention: arm 2: Vehicle b.d. |
|
|
Country: United Kingdom Study type: RCT |
N=40 Sex: mixed Number randomised: arm 1: n=20 Number randomised: arm 2: n=20 Inclusion details: Participants aged between 16 and 45 years with mild to moderate facial inflammatory acne defined as the presence of at least 10 acne papules or pustules between the brow and jaw line and an acne severity score of between 2 and 7 on the Leeds revised acne grading system. |
Intervention: arm 1: ACNICARE (triethyl citrate + ethyl linoleate) topical b.d. Intervention: arm 2: Vehicle topical b.d. |
|
|
Country: United Kingdom Study type: RCT |
N=79 Sex: mixed Number randomised: arm 1: n=40 Number randomised: arm 2: n=39 Inclusion details: Acne vulgaris, aged 13 to 30. Baseline or screening P acnes counts on facial skin (cheek or forehead) had to be at least 104 colony-forming units (CFUs) per square centimetre, of which no more than 104 CFU/cm 2 could be erythromycin or clindamycin resistant. Eligible patients also had to have 15 to 100 inflammatory lesions, 15 to 100 comedones, and <2 nodules/cysts on the face. Sexually active female patients were required to use contraception for 28 days before the start and for the duration of the study. |
Intervention: arm 1: topical clindamycin 1% / BPO 5% gel b.d. Intervention: arm 2: topical clindamycin 1% |
|
|
Country: India Study type: RCT |
N=40 Sex: mixed Number randomised: arm 1: n=20 Number randomised: arm 2: n=20 Inclusion details: Mild-to-moderate (grade I and grade II) facial acne vulgaris, graded using a system taking into account the predominant lesions present: Grade 1 (mild): comedones, occasional papules. Grade 2 (moderate): papules, comedones, few pustules. Grade 3 (severe): predominant pustules, nodules, abscesses. Grade 4 (cystic): mainly cysts, abscesses, widespread scarring. |
Intervention: arm 1: salicylic acid 30% Intervention: arm 2: Jessner’s peel |
|
|
Country: India Study type: RCT |
N=50 Sex: mixed Number randomised: arm 1: n=25 Number randomised: arm 2: n=25 Inclusion details: Mild-to-moderate (grade I and grade II) facial acne vulgaris on the Vaishampayan grading system. |
Intervention: arm 1: 30% salicylic acid peel Intervention: arm 2: 45% mandelic acid peel |
|
|
Country: India Study type: RCT |
N=100 Sex: mixed Number randomised: arm 1: n=50 Number randomised: arm 2: n=50 Inclusion details: Male and non-pregnant participants aged between 12 and 30 years. Participants with mild to moderate acne vulgaris; based on simple acne grading scale (grade 1 to grade 4). Participants with only comedones as noninflammatory lesions, and papules and pustules as inflammatory lesions were included in the study (mild to moderate acne vulgaris- grades 1 and 2). |
Intervention: arm 1: adapalene (0.1%) o.d. Intervention: arm 2: benzoyl peroxide (2.5%) clindamycin (1%) combination o.d. |
|
|
Country: North America Study type: RCT |
N=2238 Sex: mixed Number randomised: arm 1: n=1118 Number randomised: arm 2: n=1120 Inclusion details: At least 12 years of age, with a diagnosis of acne, with 20–50 facial inflammatory lesions (papules and pustules) and 30–100 facial noninflammatory lesions (open and closed comedones), and with an acne grade of 3 (indicating moderate severity) on the Global Acne Assessment Score (GAAS) at screening and at baseline. |
Intervention: arm 1: Topical dapsone 7.5% gel o.d. Intervention: arm 2: Topical vehicle o.d. |
|
|
Country: North America/Europe Study type: RCT |
N=1670 Sex: mixed Number randomised: arm 1: n=419 Number randomised: arm 2: n=418 Number randomised: arm 3: n=415 Number randomised: arm 4: n=418 Inclusion details: 12 years of age or older with acne vulgaris, having on the face 20–50 inflammatory lesions, 30–100 noninflammatory lesions and an Investigator’s Global Assessment (IGA) score of 3, corresponding to moderate acne. |
Intervention: arm 1: Adapalene 0.1%–BPO 2.5% fixed combination topical gel o.d. Intervention: arm 2: Adapalene 0.1% topical gel o.d. Intervention: arm 3: BPO 2.5% topical gel o.d. Intervention: arm 4: Vehicle topical o.d. |
|
|
Country: Spain Study type: RCT |
N=168 Sex: mixed Number randomised: arm 1: n=83 Number randomised: arm 2: n=85 Inclusion details: Aged 12 to 39 years, with = 15 inflammatory lesions and/ or non-inflammatory lesions but = 3 nodulocystic lesions and an acne grade of = 2.0 and < 7.0 on the Leeds Revised Acne Grading System. |
Intervention: arm 1: topical BPO % + CLIND 1% o.d. Intervention: arm 2: Adapalene 0.1% topical gel o.d. |
|
|
Country: Iran Study type: RCT |
N=96 Sex: mixed Number randomised: arm 1: n=32 Number randomised: arm 2: n=32 Number randomised: arm 3: n=32 Inclusion details: Aged 12–28 years with mild to moderate acne vulgaris. |
Intervention: arm 1: Topical azithromycin 2% b.d. Intervention: arm 2: Topical erythromycin 2% b.d. Intervention: arm 3: Topical clindamycin 2% b.d. |
|
|
Country: Denmark Study type: RCT |
N=79 Sex: mixed Number randomised: arm 1: n=40 Number randomised: arm 2: n=39 Inclusion details: Mild to moderate acne vulgaris. |
Intervention: arm 1: Topical fucidin cream 2% Intervention: arm 2: Topical placebo cream |
|
|
Country: United Kingdom Study type: RCT |
N=77 Sex: mixed Number randomised: arm 1: n=25 Number randomised: arm 2: n=26 Number randomised: arm 3: n=26 Inclusion details: 15–100 inflamed and/or 15–100 non-inflamed lesions but no more than three nodulocystic lesions on the face. |
Intervention: arm 1: Topical isotretinoin 0.05% b.d. Intervention: arm 2: Topical BPO 5% b.d. Intervention: arm 3: Vehicle b.d. |
|
|
Country: Pakistan Study type: RCT |
N=200 Sex: mixed Number randomised: arm 1: na, n=100 completed Number randomised: arm 2: na, n=100 completed Inclusion details: More than 13 years of age, with mild to moderate acne (comedones, papulopustules and few nodules with no scarring) and free of intercurrent illness. |
Intervention: arm 1: 0.1% ADAP topical o.d. Intervention: arm 2: 4% BPO topical o.d. |
|
|
Country: India Study type: RCT |
N=40 Sex: Mixed Number randomised: arm 1: n=20 Number randomised: arm 2: n=20 Inclusion details: Moderately severe acne, with lesions on the face. |
Intervention: arm 1: 5% benzoyl peroxide topical and 1% metronidazole gel o.d. Intervention: arm 2: 5% benzoyl peroxide topical and 1% clindamycin gel o.d. |
|
|
Country: Thailand Study type: RCT |
N=201 Sex: female Number randomised: arm 1: n=100 Number randomised: arm 2: n=101 Inclusion details: Healthy females aged between 18 and 45 years with mild to moderate acne vulgaris - defined as having no more than 5 comedones or papules and no pustule while moderate acne vulgaris was defined as 6–15 comedones or papules and/or a maximum of three pustules. |
Intervention: arm 1: triphasic EE/NGM treatment at the dosage of 0.035/0.18, 0.035/0.215 and 0.035/0.25mg on days 1–7, 8–14 and 15–21, respectively, and took inactive tablets for 7 days before starting the next treatment cycle Intervention: arm 2: biphasic EE/DSG treatment at the dosage of 0.04/0.025 and 0.03/0.125mg on days 1–7 and 8–22 of each cycle, respectively, and discontinued treatment for 6 days before starting the next treatment cycle. |
|
|
Country: Thailand Study type: RCT |
N=180 Sex: female Number randomised: arm 1: n=90 Number randomised: arm 2: n=90 Inclusion details: Healthy women between the ages of 18 to 45 years with mild to moderate acne vulgaris and who had dysmenorrhea of any degree of severity. Mild acne vulgaris was defined as having comedones as the main type of acne lesion with < 10 papules and pustules. Moderate acne was defined as having 10–40 papules and pustules, 10–40 comedones, and/or mild truncal disease. |
Intervention: arm 1: EE/CMA at the dosage of 30 mcg/2 mg once daily; treatment was for 21 consecutive days, starting on the first day of the menstruation, followed by 7 days of medication free before starting the next cycle of treatment. Intervention: arm 2: received EE/DRSP at the dosage of 30 mcg/3 mg once daily; treatment was for 21 consecutive days, starting on the first day of the menstruation, followed by 7 days of medication free before starting the next cycle of treatment. |
|
|
Katsambas 1989; Trial 1 Country: Greece Study type: RCT |
N=92 Sex: mixed Number randomised: arm 1: n=43 Number randomised: arm 2: n=49 Inclusion details: Papulo-pustular acne (degree II/III of Plewig-Kligmann). |
Intervention: arm 1: 20% azelaic acid cream Intervention: arm 2: vehicle |
|
|
Country: India Study type: RCT |
N=26 Sex: Mixed Number randomised: arm 1: na, n=12 completed Number randomised: arm 2: na, n=14 completed Inclusion details: Moderately severe acne - defined as the presence, on the face (above the jawline) of the subject, of 5–15 inflammatory lesions (IN) but no more than 5 nodulocystic lesions and / or more than 50 non-inflammatory (NI) acne lesions. |
Intervention: arm 1: topical clindamycin hydrochloride 1% twice a day Intervention: arm 2: hydro-alcoholic vehicle twice a day |
|
|
Country: Poland Study type: RCT |
N=127 Sex: Mixed Number randomised: arm 1: n=43 Number randomised: arm 2: n=42 Number randomised: arm 3: n=42 Inclusion details: Acne vulgaris of the face (15–100 inflammatory lesions and/or 15–100 non-inflammatory lesions, but not more than three nodulocystic lesions). |
Intervention: arm 1: isotretinoin 0.05%w/w cream formulated with standard sunscreen Intervention: arm 2: isotretinoin (0.10%w/w) cream formulated with standard sunscreen Intervention: arm 3: placebo vehicle sunscreen cream |
|
|
Country: United States Study type: RCT |
N=109 Sex: Mixed Number randomised: arm 1: n=55 Number randomised: arm 2: n=54 Inclusion details: At least 14 years of age and had to have a minimum of ten but no more than sixty facial papules and pustules, and no more than six facial nodular cystic lesions. |
Intervention: arm 1: 2% erythromycin gel Intervention: arm 2: clindamycin phosphate 1 % solution |
|
|
Country: United States Study type: RCT |
N=371 Sex: Female Number randomised: arm 1: n=185 Number randomised: arm 2: n=186 Inclusion details: Healthy women, at least 14 years of age, with regular menstrual cycles and moderate facial acne. Moderate facial acne was defined as a total facial count of 6 to 200 noninflammatory comedones, 10 to 75 inflammatory lesions (papules and pustules), and 5 or fewer nodules. Also required a normal Papanicolaou test result within the past 6 months or a low-grade abnormal Papanicolaou test result under medical evaluation, a negative pregnancy test result, and agreement to use a nonhormonal method of contraception if at risk for pregnancy. |
Intervention: arm 1: tablets containing 20g of EE and 100g of LNG in a 28-day blister pack with 21 days of active medication followed by 7 days of placebo Intervention: arm 2: Placebo oral |
|
|
Country: Poland Study type: RCT |
N=240 Sex: mixed Number randomised: arm 1: n=120 Number randomised: arm 2: n=120 Inclusion details: 14 years or older with a clinical diagnosis of moderate acne vulgaris. |
Intervention: arm 1: Azithromycin 500mg o.d. for 3 days in the first week, followed by 500-mg tablets weekly to complete 10 weeks of treatment. Intervention: arm 2: Doxycycline (Hiramicin) 100-mg capsules twice a day on the first day of the treatment, followed by doxycycline 100-mg capsules once a day during 12 weeks of treatment. |
|
|
Country: United Kingdom Study type: RCT |
N=188 Sex: Mixed Number randomised: arm 1: n=95 Number randomised: arm 2: n=93 Inclusion details: Facial acne vulgaris having 15–100 inflammatory lesions and/or 15–100 non-inflammatory lesions, but not more than three nodulocystic lesions. |
Intervention: arm 1: gel containing isotretinoin 0.1%w/w and erythromycin 4.0%w/w in a vehicle of butylated hydroxytoluene, hydroxypropylcellulose and ethanol Intervention: arm 2: comparator gel contained benzoyl peroxide 5.0%w/w and erythromycin 3.0%w/w |
|
|
Country: Italy Study type: RCT |
N=60 Sex: Mixed Number randomised: arm 1: n=30 Number randomised: arm 2: n=30 Inclusion details: 15–35 years with mild to moderate acne vulgaris, defined as at least 10 inflammatory lesions and 10 non-inflamatory lesions, and no more than two nodulo-cystic lesions. |
Intervention: arm 1: Hydrogen peroxide gel (Crystacide 1%) Intervention: arm 2: Benzoyl peroxide gel (PanOxyl 4%) |
|
|
Country: United Kingdom Study type: RCT |
N=649 Sex: mixed Number randomised: arm 1: n=131 Number randomised: arm 2: n=130 Number randomised: arm 3: n=130 Number randomised: arm 4: n=127 Number randomised: arm 5: n=131 Inclusion details: Mild to moderate acne vulgaris (acne grade 3·0 or less) and at least 15 inflamed and 15 non-inflamed lesions on the face. |
Intervention: arm 1: OXYTETRA-oral 500mg b.d. + PLC-topical Intervention: arm 2: MINO-oral 100mg + PLC-topical Intervention: arm 3: BPO- topical 5% + PLC-oral Intervention: arm 4: Combined formulation of BPO- topical 5%/ERYTH-topical 3%+ PLC-oral Intervention: arm 5: BPO-topical 5% + ERYTH-topical 2% + PLC-oral |
|
|
Country: Europe Study type: RCT |
N=1338 Sex: female Number randomised: arm 1: n=530 Number randomised: arm 2: n=541 Number randomised: arm 3: n=267 Inclusion details: Female patients between 16 and 45 years old with mild to moderate papulopustular acne and without contraindications to COC use. Mild to moderate facial papulopustular acne was defined as 10–50 comedones (non-inflammatory lesions), 10–50 papules and pustules together (inflammatory lesions) and not more than three small nodules (inflammatory lesions); a normal Papanicolaou test result within the past 6 months; use of a non-hormonal method of contraception for sexually active patients. |
Intervention: arm 1: EE-oral 0.030mg + DNG-oral 2mg Intervention: arm 2: CPA-oral (2mg) + EE-oral (0.035mg) Intervention: arm 3: PLC-oral |
|
|
Country: United Kingdom Study type: RCT |
N=107 Sex: mixed Number randomised: arm 1: n=27 Number randomised: arm 2: n=30 Number randomised: arm 3: n=25 Number randomised: arm 4: n=25 Inclusion details: Mild to moderate acne, age ranging from 14 to 50 years, otherwise healthy. |
Intervention: arm 1: BLU-PT 415nm Intervention: arm 2: BR-LED 415 and 660nm Intervention: arm 3: White light control Intervention: arm 4: BPO-topical 5% |
|
|
Country: Iran Study type: RCT |
N=126 Sex: mixed Number randomised: arm 1: na, n=35 completed Number randomised: arm 2: na, n=31 completed Number randomised: arm 3: na, n=40 completed Number randomised: arm 4: n=20 Inclusion details: Age between 14 and 40 years, mild-to-moderate forms of acne vulgaris with at least 10 inflammatory lesions on the face (with a maximum of three nodules). |
Intervention: arm 1: Azelaic acid 5% gel Intervention: arm 2: Erythromycin 2% gel Intervention: arm 3: Azelaic acid 5% + Erythromycin 2% gel Intervention: arm 4: Placebo |
|
|
Country: Iran Study type: RCT |
N=150 Sex: mixed Number randomised: arm 1: n=50 Number randomised: arm 2: n=50 Number randomised: arm 3: n=50 Inclusion details: Age between 14 and 40 years, mild-to-moderate forms of acne vulgaris with at least 10 inflammatory lesions on the face . |
Intervention: arm 1: Azelaic acid 5% gel Intervention: arm 2: Clindamycin 2% gel Intervention: arm 3: Azelaic acid + Clindamycin gel |
|
|
Country: Europe Study type: RCT |
N=377 Sex: women Number randomised: arm 1: n=251 Number randomised: arm 2: n=126 Inclusion details: Women with moderate papulopustular acne of the face (8– 75 papules and/or pustules) aged between 18 and 40 years (smokers up to 30 years). |
Intervention: arm 1: Ethinyl estradiol 0.03mg + chlormadinone acetate 2mg Intervention: arm 2: Placebo |
|
|
Country: France Study type: RCT |
N=81 Sex: mixed Number randomised: arm 1: n=42 Number randomised: arm 2: n=39 Inclusion details: Greasy or normal or combination skin type, with phototypes II–IV, presenting with inflammatory (7–15 lesions) and retentional (15–30 lesions) mild to moderate acne vulgaris. |
Intervention: arm 1: Diacneal (0.1% retinaldehyde and 6% glycolic acid) Intervention: arm 2: Vehicle |
|
|
Country: New Zealand Study type: RCT |
N=58 Sex: mixed Number randomised: arm 1: n=29 Number randomised: arm 2: n=29 Inclusion details: 25–55 years of age, with low-grade adult acne - defined as three or more acne lesions/month on the face, for at least the last 3 months. |
Intervention: arm 1: 5mg isotretinoin once daily Intervention: arm 2: No treatment for 16 weeks |
|
|
Country: Egypt Study type: RCT |
N=25 Sex: mixed Number randomised: arm 1: n=15 Number randomised: arm 2: n=10 Inclusion details: Participants aged 14 years or over. Participants with mild to moderate acne vulgaris; determined by Evaluator Global Severity score.Score of 2 or 3 on scale before treatment. |
Intervention: arm 1: PDT using 5-aminolevulinic acid (ALA) with intense pulsed light (IPL) Intervention: arm 2: IPL alone |
|
|
Country: Iran Study type: RCT |
N=144 Sex: mixed Number randomised: arm 1: na, n=74 completed Number randomised: arm 2: na, n=74 completed Inclusion details: Inflammatory acne vulgaris, at least 20 comedones, or with nodules or cysts disregarding the number of comedones. |
Intervention: arm 1: 500mg azithromycin/day, 3 days a week + oral levamisole 150mg/day, 2 days a week Intervention: arm 2: 500mg azithromycin/day, 3 days a week |
|
|
Country: India Study type: RCT |
N=45 Sex: mixed Number randomised: arm 1: n=15 Number randomised: arm 2: n=15 Number randomised: arm 3: n=15 Inclusion details: Patients with acne (grade 1 and 2) with postacne hyperpigmentation. Patients aged >12 years. |
Intervention: arm 1: 35% glycolic acid peel Intervention: arm 2: 20% salicylic acid-10% mandelic acid Intervention: arm 3: Phytic acid |
|
|
Country: Germany Study type: RCT |
N=217 Sex: mixed Number randomised: arm 1: n=108 Number randomised: arm 2: n=109 Inclusion details: 12–45 years old, having facial acne vulgaris (defined as having 17–60 inflammatory lesions [papules and pustules], =1 facial nodular cystic lesion, 20–125 non-inflammatory facial lesions and an Investigator’s Static Global Assessment [ISGA] score of ‘mild’ or ‘moderate’). |
Intervention: arm 1: Benzoyl peroxide 3% + clindamycin 1% QD Intervention: arm 2: Azelaic acid 20% BID |
|
|
Country: United Kingdom Study type: RCT |
N=41 Sex: mixed Number randomised: arm 1: n=31 Number randomised: arm 2: n=10 Inclusion details: Aged between 18 and 45 years with mild-to-moderate facial inflammatory acne defined as the presence of at least ten acne papules or pustules between the brow and jawline and an acne severity score of between 2 and 7 on the Leeds revised acne grading system. |
Intervention: arm 1: Pulsed dye laser Intervention: arm 2: Sham laser |
|
|
Country: United States Study type: RCT |
N=49 Sex: mixed Number randomised: arm 1: n=25 Number randomised: arm 2: n=24 Inclusion details: Teenagers (12 to 20) with mild to moderate acne vulgaris, classed by Pillsbury, Shelly and Kligman grades I or II, with at least fifteen comedones and no more than ten inflammatory lesions. |
Intervention: arm 1: 0.5% salicylic acid (Stri-Dex medicated pads) Intervention: arm 2: Placebo |
|
|
Country: United States Study type: RCT |
N=1026 Sex: mixed Number randomised: arm 1: n=386 Number randomised: arm 2: n=127 Number randomised: arm 3: n=385 Number randomised: arm 4: n=128 Inclusion details: 12 years of age or older with mild to moderate facial acne vulgaris and an Investigator’s Static Global Assessment (ISGA) score of 2 or greater at baseline. Also a minimum of 17 but no more than 40 facial inflammatory lesions, including nasal lesions, and a minimum of 20, but no more than 150 facial non-inflammatory lesions, excluding nasal lesions. |
Intervention: arm 1: Clindamycin foam o.d. Intervention: arm 2: Vehicle foam o.d. Intervention: arm 3: Clindamycin gel 1% o.d. Intervention: arm 4: Vehicle gel o.d. |
|
|
Country: India Study type: RCT |
N=120 Sex: mixed Number randomised: arm 1: n=60 Number randomised: arm 2: n=60 Inclusion details: Mild to moderate acne on face as per Indian Acne Alliance Grading for Severity of acne, aged between 12 to 25 years. |
Intervention: arm 1: topical 1% clindamycin + 0.1% adapalene Intervention: arm 2: topical 1% clindamycin + 2.5 % benzoyl peroxide |
|
|
Country: United States Study type: RCT |
N=59 Sex: mixed Number randomised: arm 1: n=29 Number randomised: arm 2: n=30 Inclusion details: At least ten inflammatory papules and/or pustules and no more than three nodulocystic lesions on the face, otherwise in good health. |
Intervention: arm 1: 20% Benzoyl-peroxide b.d. Intervention: arm 2: Vehicle b.d. |
|
|
Country: United States Study type: RCT |
N=2102 Sex: mixed. Number randomised: arm 1: 1044 Number randomised: arm 2: 1058 Inclusion details: Moderate acne, with 20 to 50 inflammatory lesions (papules and pustules) and 30 to 100 noninflammatory lesions (open and closed comedones) on the face. Patients were also required to have an acne grade of 3 (indicating moderate acne) on the Global Acne Assessment Score. Males and females. |
Intervention: arm 1: Dapsone gel 7.5%. Intervention: arm 2: Vehicle |
|
|
Country: Italy Study type: RCT |
N=65 Sex: mixed Number randomised: arm 1: n=25 Number randomised: arm 2: n=20 Number randomised: arm 3: n=20 Inclusion details: Mild or moderate comedonic or papulopustular acne, localized on the face. each patient had a minimum of 20 facial non-inflammatory lesions (open and closed comedones) and 10 inflamed lesions. Also required to be in good health and have not received any oral or topical anti-acne therapy in the 8 weeks prior the study. |
Intervention: arm 1: Azelaic acid o.d. Intervention: arm 2: Benzoyl peroxide o.d. Intervention: arm 3: Adapalene o.d. |
|
|
Country: United States Study type: RCT |
N=110 Sex: mixed Number randomised: arm 1: n=55 Number randomised: arm 2: n=55 Inclusion details: Helathy participants aged between 12 and 35 years and with a minimum of 10 erythematous facial papules and pustules. |
Intervention: arm 1: Chlorhexidine gluconate skin solution Intervention: arm 2: vehicle |
|
|
Country: North America Study type: RCT |
N=653 Sex: mixed Number randomised: arm 1: n=261 Number randomised: arm 2: n=258 Number randomised: arm 3: n=134 Inclusion details: Participants 12 years or older, with 20 to 100 noninflammatory facial lesions, 20 to 50 inflammatory facial lesions, and no nodules or cysts; specified washout periods were required for participants taking certain topical and systemic treatments. |
Intervention: arm 1: Adapalene 0.1% gel Intervention: arm 2: Adapalene 0.3% gel Intervention: arm 2: Vehicle |
|
|
Country: Germany Study type: RCT |
N=1154 Sex: female Number randomised: arm 1: n=568 Number randomised: arm 2: n=586 Inclusion details: Otherwise healthy female subjects ranging in age from 15 to 40 years without contraindications for combined oral contraceptive use with mild to moderate acne vulgaris, having 6 to 100 comedones (noninflammatory lesions), 10 to 50 papules or pustules together, and not more than 5 nodules on the face (inflammatory lesions). Normal gynecologic examination and cervical smear within the last 6 months; negative pregnancy test; 3 spontaneous withdrawal bleedings following delivery, abortion, or lactation; and avoidance of comedogenic cosmetics or sunscreens, sex hormone preparations, and antiacne therapy. |
Intervention: arm 1: 30micrograms ethinyl estradiol + 3milligrams drospirenone Intervention: arm 2: 35micrograms ethinyl estradiol + 0.18, 0.215, 0.25 mg norgestimate |
|
|
Country: Mexico Study type: RCT |
N=171 Sex: mixed Number randomised: arm 1: n=43 Number randomised: arm 2: n=43 Number randomised: arm 3: n=45 Number randomised: arm 4: n=40 Inclusion details: 18 years or older with at least ten noninflammatory acne lesions and <30 inflammatory lesions on the entire face. Patients with childbearing potential were required to use birth control and to have a negative pregnancy test result at the beginning of the study. |
Intervention: arm 1: Adapalene 0.1% gel Intervention: arm 2: Adapalene 0,3% gel Intervention: arm 3: Tretinoin 0.05% gel Intervention: arm 4: Placebo gel |
|
|
Country: Romania Study type: RCT |
N=47 Sex: men Number randomised: arm 1: n=32 Number randomised: arm 2: n=15 Inclusion details: White-skinned men with acne vulgaris of the face of mild-to-moderate severity, with a score of 2 or 3 on IGA, and with TLC between 20 and 100, and ILC between 10 and 50. |
Intervention: arm 1: Tretinoin 0.05% cream Intervention: arm 2: Vehicle |
|
|
Country: China Study type: RCT |
N=150 Sex: mixed Number randomised: arm 1: n=75 Number randomised: arm 2: n=75 Inclusion details: Grade II–III acne vulgaris |
Intervention: arm 1: Adapalene gel 0.1% Intervention: arm 2: Tretinoin gel 0.025% |
|
|
Country: United States Study type: RCT |
N=143 Sex: Mixed Number randomised: arm 1: n=72 Number randomised: arm 2: n=71 Inclusion details: At least 12 years old with mild to moderate facial acne vulgaris, defined as 10 to 60 facial inflammatory lesions, 10 to 200 facial noninflammatory lesions, and no more than 2 facial nodular cystic lesions (none more than 5mm in diameter). |
Intervention: arm 1: once-daily application of tazarotene 0.1% gel Intervention: arm 2: tretinoin 0.025% gel |
|
|
Country: China Study type: RCT |
N=1016 Sex: Mixed Number randomised: arm 1: n=500 Number randomised: arm 2: n=516 Inclusion details: Aged 12–45 years (inclusive) diagnosed with mild to moderate acne, with at least 17, but not more than 60 facial inflammatory lesions (papules plus pustules), at least 20 but not more than 125 facial non-inflammatory lesions (open and closed comedones), no more than 1 facial nodular lesion with no cystic lesions, and who had a baseline Investigator’s Static Global Assessment (ISGA) score of 2 or 3. |
Intervention: arm 1: topical clindamycin 1%/benzoyl peroxide 5% once-daily gel Intervention: arm 2: clindamycin 1% twice-daily gel |
|
Abbreviations: AZE + SAL peel: azelaic acid and salicylic acid peel; 1319-LSR: 1319 nm laser photochemical therapy; 589-LSR: 589 nm laser photochemical therapy; 5ALA: 5-aminolevulinic acid withunspecified light source; 5ALA-IPL-PDT: 5 aminolevulinic acid using intense pulsed light; 5ALA-KTP-PDT: 5-aminolevulinic acid using KTP (potassium titanyl phosphate) laser; 5ALA-PDL-PDT: 5-aminolevulinic acid using pulsed dye laser; 5ALA-RED-PDT: 5-aminolevulinic acid using red light; 5ARI: 5-alpha-reductase inhibitors; ACTINAC: Actinac (4% chloramphenicol, 4% hydrocortisone acetate, 2.4% butoxyethyl nicotinate, 2.4% allantoin, 32% precipitated sulphur); ADAP + BPO: adapalene + benzoyl peroxide; ADAP: adapalene; AFA peel: amino fruit acid (available in creams, pads, lotions); AZE: azelaic acid; AZITH:azithromycin; BIFON: bifonazole; BiRF: bipolar radiofrequency; BLU-PT: blue light emitting diode therapy (LED) photochemical therapy; BPO + CLIND: benzoyl peroxide 5%/clindamycin 1%; BPO: benzoyl peroxide; BR-LED: blue + red light; BUTEN: butenifine; CD271: CD 271 alcoholic gel; CHLOR: chlorhexidine gluconate/digluconate; CIPRO: ciprofloxacine; CLIND: clindamycin; CLIND + TRET: clindamycin 1% + tretioin 0.025%; CLIND+ ZINC: clindamycin with zinc acetatedihydrate; CMA: chlormadinone acetate; CO2: fractional CO2 laser; CPA + EE: co-cyprindiol (ethinylestradiol with cyproterone acetate); CPA: cyproterone acetate; DAPS: dapsone; DEM: demeclocycline; DOXY: doxycycline; DRSP: drospirenone; EE + DNG: estradiol (valerate) + dienogest; EE + DROS: ethinylestradiol + drospirenone; EE + LNG: ethinylestradiol+levonorgestrel; EE: ethinylestradiol; EE+DSGethinylestradiol+ desogestrel; EE+NGM: ethinylestradiol+norgestimate; ERYTH + ZINC: erythromycin with zinc acetate dihydrate; ERYTH:erythromycin; FCA: fucidic acid (sodium fusidate); FMR: fractional microneedling radiofrequency; GLY peel: glycolic acid; GOLDMP: gold microparticles; HPS: hydrogen peroxide; IPL: intense pulsed light; IPL+VAC: intense pulsed light + vacuum; IRL: near infrared light; ISO<120.Alt<0.5: isotretinoin ≥0.5mg/kg/every other day total cumulative dose < 120mg/kg; ISO<120.Alt≥0.5: isotretinoin <0.5mg/kg/every other day total cumulative dose < 120mg/kg; ISO<120.Daily<0.5: isotretinoin ≥0.5mg/kg/day total cumulative dose < 120mg/kg; ISO<120.Daily≥0.5: isotretinoin<0.5mg/kg/day total cumulative dose < 120mg/kg; ISO<120.Other<0.5: isotretinoin≥0.5mg/kg/less frequently total cumulative dose < 120mg/kg; ISO<120.Other≥0.5: isotretinoin<0.5mg/kg/less frequently total cumulative dose < 120mg/kg; ISO≥120.Alt<0.5: isotretinoin≥0.5mg/kg/every other day total cumulative dose >= 120mg/kg; ISO≥120.Alt≥0.5: isotretinoin<0.5mg/kg/every other day total cumulative dose >= 120mg/kg; ISO≥120.Daily<0.5: ISOisotretinoin ≥0.5mg/kg/day total cumulative dose >= 120mg/kg; ISO≥120.Daily≥0.5: isotretinoin<0.5mg/kg/day total cumulative dose >= 120mg/kg; ISO≥120.Other<0.5: isotretinoin≥0.5mg/kg/less frequently total cumulative dose >= 120mg/kg; ISO≥120.Other≥0.5: isotretinoin<0.5mg/kg/less frequently total cumulative dose >= 120mg/kg; ISO: isotretinoin; JES peel: Jessner’s peel; KTP: potassium titanyl phosphate laser; LEVA: levamisole; LNG: levonorgestrel; LYME: lymecycline; MAL with occlusion: methyl aminolevulinate ; MAL without occlusion: methylaminolevulinate ; MAL-DL-PDT: methyl aminolevulinate using daylight; MAL-IPL-PDT: methyl aminolevulinate using intense pulsed light; MAL-KTP-PDT: methyl aminolevulinate using potassium titanyl phosphate (KTP) laser; MAL-RED-PDT: methyl aminolevulinate using red light; MD: microdermabrasion; METF: metformin; MET: metronidazole; MICO: miconazole nitrate; MINO: minocycline; MOT:motretinide; n: number of participants randomised/completed to/in each trial arm; NAD:nadifloxacin; NAFL: fractional erbiumglass laser; NBUVB: nearband ultraviolet light; Nd:YAG: long-pulse neodymium-doped yttrium aluminum garnet laser; NELS: Nels Cream (chloroxylenol + zinc oxide); NICO: nicotinamide (NIACINAMID); no!no!: no!no! skin device (broad spectrum light of 450–2000nm, 6 J/cm-2); NOR + EE:norethisterone + ethinylestradiol; OXYTETRA: oxytetracycline; PBBL: pneumatic broadband light therapy; PDL: pulsed dye laser; PLC: placebo; PLC-physical: sham physical treatment; PRED:prednisolone; PYA peel: pyruvic acid; RED: red light; RETINOL: retinol (vitamin A); ROXI: roxithromycin; SAL peel: salicylic acid; SARE:sarecyclin; SOS: superoxidised solution (an electrochemically processed aqueous solution manufactured from pure water and sodium chloride); SPIRO: spironolactone; TAZ:tazarotene; TCA peel: trichloroaecetic acid; TETRA: tetracycline;TRET: tretinoin (retin A, all-trans reinoic acid); TRIC: triclozan;; ZINCG: zinc gluconate.
Final
Evidence review underpinning recommendations 1.5.1, 1.5.2 and 1.5.5 to 1.5.14 (excluding 1.5.6 which is underpinned by evidence review L, 1.5.10 and bullet points 2 and 3 of recommendation 1.5.12 which are underpinned by evidence review F1 and 3 research recommendations in the NICE guideline - see evidence review E1 for the committee’s discussion of the evidence)
These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.