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people with acne vulgaris</span></h1><div class="subtitle">Acne vulgaris: management</div><p><b>Evidence review B</b></p><p><i>NICE Guideline, No. 198</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4147-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng198er2.s1"><h2 id="_niceng198er2_s1_">Skin care advice for people with acne vulgaris</h2><div id="niceng198er2.s1.1"><h3>Review question</h3><p>What skin care advice is appropriate for people with acne vulgaris?</p><div id="niceng198er2.s1.1.1"><h4>Introduction</h4><p>People with acne vulgaris need to look after their skin. This will include day-to-day care of the skin, for example cleansing, applying a moisturiser or a sunscreen and when necessary using active medical treatments. Effective skin care is of particular importance for people with acne vulgaris as it will help to ameliorate the effects of treatment and reduce the likelihood of everyday products worsening acne.</p></div><div id="niceng198er2.s1.1.2"><h4>Summary of the protocol</h4><p>Please see <a class="figpopup" href="/books/NBK573057/table/niceng198er2.tab1/?report=objectonly" target="object" rid-figpopup="figniceng198er2tab1" rid-ob="figobniceng198er2tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng198er2tab1"><a href="/books/NBK573057/table/niceng198er2.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng198er2tab1" rid-ob="figobniceng198er2tab1"><img class="small-thumb" src="/books/NBK573057/table/niceng198er2.tab1/?report=thumb" src-large="/books/NBK573057/table/niceng198er2.tab1/?report=previmg" alt="Table 1. Summary of the protocol." /></a><div class="icnblk_cntnt"><h4 id="niceng198er2.tab1"><a href="/books/NBK573057/table/niceng198er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng198er2tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol. </p></div></div><p>For further details see the review protocol in <a href="#niceng198er2.appa">appendix A</a>.</p></div><div id="niceng198er2.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng198er2.appa">appendix A</a> and the methods document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng198er2.s1.1.4"><h4>Clinical evidence</h4><div id="niceng198er2.s1.1.4.1"><h5>Included studies</h5><p>Overall three randomised controlled trials (RCTs) were included in this review, of which 2 were parallel group studies (<a class="bibr" href="#niceng198er2.s1.1.ref2" rid="niceng198er2.s1.1.ref2">Korting 1995</a>, <a class="bibr" href="#niceng198er2.s1.1.ref3" rid="niceng198er2.s1.1.ref3">Santos-Caetano 2019</a>) and 1 was a split-face trial (<a class="bibr" href="#niceng198er2.s1.1.ref1" rid="niceng198er2.s1.1.ref1">Choi 2010</a>).</p><p>One study was conducted in South Korea (<a class="bibr" href="#niceng198er2.s1.1.ref1" rid="niceng198er2.s1.1.ref1">Choi 2010</a>), 1 in Germany (<a class="bibr" href="#niceng198er2.s1.1.ref2" rid="niceng198er2.s1.1.ref2">Korting 1995</a>) and 1 in the USA (<a class="bibr" href="#niceng198er2.s1.1.ref3" rid="niceng198er2.s1.1.ref3">Santos-Caetano 2019</a>). All studies included both men and women. Two studies focused on people with mild acne vulgaris (<a class="bibr" href="#niceng198er2.s1.1.ref1" rid="niceng198er2.s1.1.ref1">Choi 2010</a>, <a class="bibr" href="#niceng198er2.s1.1.ref2" rid="niceng198er2.s1.1.ref2">Korting 1995</a>) and 1 on mild to moderate acne vulgaris (<a class="bibr" href="#niceng198er2.s1.1.ref3" rid="niceng198er2.s1.1.ref3">Santos-Caetano 2019</a>). The sample size of the studies ranged from 13 to 122 participants.</p><p>All included studies compared different types of skincare products. One parallel-group study compared an acidic syndet (short for synthetic detergent which had a pH in solution: 5.5 to 5.6) bar called ‘Sebamed compact’ to a conventional ‘Lux’ soap bar (<a class="bibr" href="#niceng198er2.s1.1.ref2" rid="niceng198er2.s1.1.ref2">Korting 1995</a>), whilst another compared reformulated 4% and 10% benzoyl peroxide face washes to an older (and no longer commercially available) 10% formulation face wash (<a class="bibr" href="#niceng198er2.s1.1.ref3" rid="niceng198er2.s1.1.ref3">Santos-Caetano 2019</a>). One split-face study compared an enhanced face cleanser containing papain, proteomax, soap powder and 0.04% triclosan, 1% salicylic acid and 1% azelaic acid to a cleanser containing papain, proteomax and soap powder only (<a class="bibr" href="#niceng198er2.s1.1.ref1" rid="niceng198er2.s1.1.ref1">Choi 2010</a>).</p><p>Evidence was identified for some outcomes such as change in acne severity (change in inflammatory and non-inflammatory lesion counts), skin-related adverse events and satisfaction with the study product.</p><p>No evidence was identified for self-reported change of acne severity and skin-specific quality of life. The included studies are summarised in <a class="figpopup" href="/books/NBK573057/table/niceng198er2.tab2/?report=objectonly" target="object" rid-figpopup="figniceng198er2tab2" rid-ob="figobniceng198er2tab2">Table 2</a>.</p></div><div id="niceng198er2.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng198er2.appk">appendix K</a>.</p></div></div><div id="niceng198er2.s1.1.5"><h4>Summary of clinical studies included in the evidence review</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK573057/table/niceng198er2.tab2/?report=objectonly" target="object" rid-figpopup="figniceng198er2tab2" rid-ob="figobniceng198er2tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng198er2tab2"><a href="/books/NBK573057/table/niceng198er2.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng198er2tab2" rid-ob="figobniceng198er2tab2"><img class="small-thumb" src="/books/NBK573057/table/niceng198er2.tab2/?report=thumb" src-large="/books/NBK573057/table/niceng198er2.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng198er2.tab2"><a href="/books/NBK573057/table/niceng198er2.tab2/?report=objectonly" target="object" rid-ob="figobniceng198er2tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng198er2.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng198er2.appe">appendix E</a>).</p></div><div id="niceng198er2.s1.1.6"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>See the evidence profiles in <a href="#niceng198er2.appf">appendix F</a>.</p></div><div id="niceng198er2.s1.1.7"><h4>Economic evidence</h4><div id="niceng198er2.s1.1.7.1"><h5>Included studies</h5><p>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 <a href="#niceng198er2.appb">appendix B</a> and economic study selection flow chart in <a href="#niceng198er2.appg">appendix G</a>.</p></div><div id="niceng198er2.s1.1.7.2"><h5>Excluded studies</h5><p>No economic studies were reviewed at full text and excluded from this review.</p></div></div><div id="niceng198er2.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng198er2.s1.1.9"><h4>The committee’s discussion of the evidence</h4><div id="niceng198er2.s1.1.9.1"><h5>Interpreting the evidence</h5><div id="niceng198er2.s1.1.9.1.1"><h5>The outcomes that matter most</h5><p>Change of acne severity during and at the end of treatment (investigator reported or self-reported, reduction in inflammation and number of acne lesions) were prioritised by the committee as critical outcomes because they indicate whether the treatment is efficacious. Disease-specific health-related quality of life was another critical outcome because it indicates whether the person with acne vulgaris perceives an improvement in acne symptoms. Skin-related adverse events were chosen as a critical outcome and satisfaction with treatment as an important outcome because they indicate whether the intervention is safe in the short-term and the acceptability of the intervention.</p></div><div id="niceng198er2.s1.1.9.1.2"><h5>The quality of the evidence</h5><p>The quality of the evidence ranged from very low to moderate, with most of the evidence being of a low quality. This was predominately due to risk of bias of individual studies and imprecision of the effect estimates. Two studies were sponsored by industry.</p></div><div id="niceng198er2.s1.1.9.1.3"><h5>Benefits and harms</h5><p>Overall, the evidence on the use of skin care products was very limited. The committee recommended that advising the use of a syndet skin cleansing product for acne vulgaris affected areas, ideally twice daily, should be considered as the evidence suggests that this reduces inflammatory and non-inflammatory acne lesion counts. These bars have a non-alkaline (skin pH neutral or slightly acidic), whereas traditional soap bars are alkaline, therefore syndet skin cleansing products are less irritant to the skin than traditional soap bars. The committee also discussed that, although the research was carried out on a syndet bar, many syndets are now available in different formulations such as liquid or foam, and they agreed that different formulations are probably similarly effective. The committee discussed that the costs of syndets varies and noted that it would be reasonable to try the cheapest syndet in the first instance.</p><p>No relevant evidence on the use of other skin-care products such as oil-free products or make-up was identified. However, the committee agreed that it was important to say something about the use of skin care products as many people affected by acne vulgaris are concerned about them. Therefore, based on their knowledge and experience, they recommended that people with acne vulgaris should be advised to avoid applying oil-based and comedogenic (i.e. likely to block pores) products whenever possible as these could worsen their acne vulgaris. They agreed that oil-based and comedogenic skin care products (moisturisers and sunscreens) should be avoided. They also recommended that people with acne vulgaris using make-up should be advised to avoid oil-based and comedogenic products and to remove make-up at the end of the day. They discussed that in their experience oil-based and comedogenic products can make acne vulgaris worse because acne is typified by excessively oily skin and skin prone to blockage of pores. The committee discussed what to use for make-up removal. They agreed that this could be part of skin cleansing advice, using a non-alkaline (skin pH neutral or slightly acidic) syndet or in addition to it, if it is a specific area of the face (as in removal of eye make-up) or a specific type of make-up (for example long lasting make-up used in theatres) which may require a different type of cleanser. Given the lack of evidence, the committee decided that they could not be prescriptive about the products that should be used for make-up removal.</p><p>There was limited evidence of low quality on the use of acidic skin cleansers and benzoyl peroxide-based face washes. Although there was moderate quality evidence for the outcome of participants satisfied or very satisfied with the benzoyl peroxide from 1 study, the committee agreed that a recommendation could not be made based on this outcome.</p><p>Furthermore, there was little evidence of benefit for other outcomes based on low quality evidence. Therefore, the committee did not make a recommendation about these products.</p><p>The committee discussed whether a research recommendation should be made for this topic. Clinicians are frequently asked for advice regarding skin care, such as what is appropriate and effective in people with acne vulgaris. Therefore, it is an important topic for people with acne vulgaris. Due to the limited evidence the committee decided to prioritise this for a research recommendation (see <a href="#niceng198er2.appl">appendix L</a>).</p></div></div><div id="niceng198er2.s1.1.9.2"><h5>Cost effectiveness and resource use</h5><p>No economic evidence was identified for this review question. The recommendations made by the committee have minimal healthcare resource implications comprising health professionals’ time to provide advice. The types of products advised for use are generic and thus incur small costs to people with acne. As skin care products are generally paid for by the person with acne, there are no costs to the health service.</p></div></div><div id="niceng198er2.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.2.1 to 1.2.3 (recommendation 1.2.4 is supported by evidence from evidence report L- risk factors for scarring) and research recommendation 4 on skin care advice in the guideline.</p></div><div id="niceng198er2.s1.1.rl.r1"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng198er2.s1.1.ref1"><p id="p-106">
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<strong>Choi 2010</strong>
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</p>ChoiYS, SuhHS, YoonMY, MinSU, KimJS, JungJYet al. A study of the efficacy of cleansers for acne vulgaris. J Dermatolog Treat2010, 21(3):201–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/20394494" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20394494</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng198er2.s1.1.ref2"><p id="p-107">
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<strong>Korting 1995</strong>
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</p>KortingHC, Ponce-PöschlE, KlövekornW, SchmötzerG, Arens-CorellM, Braun-FalcoO. The influence of the regular use of a soap or an acidic syndet bar on pre-acne. Infection1995, 23(2):89–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/7622270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7622270</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng198er2.s1.1.ref3"><p id="p-108">
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<strong>Santos-Caetano 2019</strong>
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</p>Santos-CaetanoJP, CargillMR. A Randomized Controlled Tolerability Study to Evaluate Reformulated Benzoyl Peroxide Face Washes for Acne Vulgaris. J Drugs Dermatol2019, 18(4):350–356 [<a href="https://pubmed.ncbi.nlm.nih.gov/31012563" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31012563</span></a>]</div></p></li></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng198er2.appa"><h3>Appendix A. Review protocol</h3><div id="niceng198er2.appa.s1"><h4>Review protocol for review question: What skin care advice is appropriate for people with acne vulgaris?</h4><p id="niceng198er2.appa.et1"><a href="/books/NBK573057/bin/niceng198er2-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 3. Review protocol for skin care advice for people with acne vulgaris</a><span class="small"> (PDF, 299K)</span></p></div></div><div id="niceng198er2.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng198er2.appb.et1"><a href="/books/NBK573057/bin/niceng198er2-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 256K)</span></p></div><div id="niceng198er2.appc"><h3>Appendix C. Clinical evidence study selection</h3><p id="niceng198er2.appc.et1"><a href="/books/NBK573057/bin/niceng198er2-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical study selection for: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 129K)</span></p></div><div id="niceng198er2.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng198er2.appd.et1"><a href="/books/NBK573057/bin/niceng198er2-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 264K)</span></p></div><div id="niceng198er2.appe"><h3>Appendix E. Forest plots</h3><div id="niceng198er2.appe.s1"><h4>Forest plots for review question: What skin care advice is appropriate for people with acne vulgaris?</h4><p>This section includes forest plots only for outcomes that are meta-analysed. No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng198er2.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng198er2.appf.et1"><a href="/books/NBK573057/bin/niceng198er2-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 328K)</span></p></div><div id="niceng198er2.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng198er2.appg.et1"><a href="/books/NBK573057/bin/niceng198er2-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence study selection for review question: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 245K)</span></p></div><div id="niceng198er2.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng198er2.apph.s1"><h4>Economic evidence tables for review question: What skin care advice is appropriate for people with acne vulgaris?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng198er2.appi"><h3>Appendix I. Health economic evidence profiles</h3><div id="niceng198er2.appi.s1"><h4>Economic evidence profiles for review question: What skin care advice is appropriate for people with acne vulgaris?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng198er2.appj"><h3>Appendix J. Economic analysis</h3><div id="niceng198er2.appj.s1"><h4>Economic analysis for review question: What skin care advice is appropriate for people with acne vulgaris?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng198er2.appk"><h3>Appendix K. Excluded studies</h3><div id="niceng198er2.appk.s1"><h4>Excluded clinical and economic studies for review question: What skin care advice is appropriate for people with acne vulgaris?</h4></div><div id="niceng198er2.appk.s2"><h4>Clinical studies</h4><p id="niceng198er2.appk.et1"><a href="/books/NBK573057/bin/niceng198er2-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 10. Excluded studies and reasons for their exclusion</a><span class="small"> (PDF, 208K)</span></p></div><div id="niceng198er2.appk.s3"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="niceng198er2.appl"><h3>Appendix L. Research recommendations</h3><p id="niceng198er2.appl.et1"><a href="/books/NBK573057/bin/niceng198er2-appl-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Research recommendations for review question: What skin care advice is appropriate for people with acne vulgaris?</a><span class="small"> (PDF, 167K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendations 1.2.1 to 1.2.3 (recommendation 1.2.4 is underpinned by evidence review L) and research recommendation 4 in the NICE guideline</p><p>These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: 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.</p><p>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.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK573057</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34424620" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34424620</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng198er2tab1"><div id="niceng198er2.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573057/table/niceng198er2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng198er2.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng198er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng198er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with acne vulgaris</td></tr><tr><th id="hd_b_niceng198er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng198er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Advice regarding the use of the following skin care products or skin cleansing practices will be included:
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<ul><li class="half_rhythm"><div>Skin products:
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<ul class="circle"><li class="half_rhythm"><div>Cleansing products (e.g. cleansers, cloths, foam washes, soaps, washable solutions, washes)</div></li><li class="half_rhythm"><div>Other non-acne specific skin care products (e.g. make up; moisturisers; oily products; sun cream)</div></li></ul></div></li><li class="half_rhythm"><div>Skin cleansing practices/regimens (e.g. washing with water 5 times a day; cloth and no soap 3 times a day, and wash in evening)</div></li></ul></td></tr><tr><th id="hd_b_niceng198er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng198er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The following comparisons will be considered:
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<ul><li class="half_rhythm"><div>Any other skin care cleansing product, other non-acne specific skincare product or cleansing practice/regimen</div></li><li class="half_rhythm"><div>Placebo/sham treatment/untreated</div></li></ul></td></tr><tr><th id="hd_b_niceng198er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng198er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Critical</b>
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<ul><li class="half_rhythm"><div>Change of acne severity during and at the end of treatment
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<ul class="circle"><li class="half_rhythm"><div>Investigator-reported status</div></li><li class="half_rhythm"><div>Self-reported status</div></li><li class="half_rhythm"><div>Reduction in inflammation of acne lesions</div></li><li class="half_rhythm"><div>Reduction in number of acne lesions</div></li></ul></div></li><li class="half_rhythm"><div>Health-related quality of life
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<ul class="circle"><li class="half_rhythm"><div>Disease-specific only</div></li></ul></div></li><li class="half_rhythm"><div>Skin-related adverse events (e.g. skin irritation)</div></li></ul>
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<b>Important</b>
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<ul><li class="half_rhythm"><div>Satisfaction with treatment</div></li></ul>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng198er2tab2"><div id="niceng198er2.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573057/table/niceng198er2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng198er2.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng198er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng198er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng198er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng198er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng198er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng198er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng198er2.s1.1.ref1" rid="niceng198er2.s1.1.ref1">Choi 2010</a>
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</p>
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<p>Split-face RCT</p>
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<p>South Korea</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=13 (7 females and 6 males)</p>
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<p>Mean age: 26</p>
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<p>Facial acne severity: mild (assessed using Cunliffe’s grading system)</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Enhanced (acidic) skin cleanser containing papain, proteomax, soap powder and 0.04% triclosan, 1% salicylic acid and 1% azelaic acid</div></li></ul>
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<p>Treatment: twice daily for 4 weeks</p>
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<p>Study duration: 8 weeks but cleansers were used for first 4 weeks</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Conventional skin cleanser containing papain, proteomax and soap powder</div></li></ul>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Change in inflammatory lesion counts</div></li><li class="half_rhythm"><div>Skin-related adverse events:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">prurituis</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">scales</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">xerosis</p></dd></dl></dl></div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng198er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng198er2.s1.1.ref2" rid="niceng198er2.s1.1.ref2">Korting 1995</a>
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</p>
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<p>RCT</p>
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<p>Germany</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=114 (47 females and 67 males)</p>
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<p>Mean age (SD) in intervention group: 20.6 (3.4)</p>
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<p>Mean age (SD) in control group: 19.4 (3.2)</p>
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<p>Facial acne severity: mild (assessed using Plewig and Klingman’s grading system)</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Acidic syndet bar, pH in solution ranging from 5.5 to 5.6, containing sodium cocoyl isethionate, disodium sulfo succinate, wheat starch, paraffin, stearic acid, glyceryl stearate, cetyl palmitate, cetearyl alcohol, water, lecithin, tocopheryl acetate, perfume, lactic acid, PEG-14, disodium EDTA, hydrogenatedcoco-glyceride (and) tocopherol, urea phosphate, glycine, aspartic acid, alanine, pyridoxine hydrochtoride, lysine, leucine, C.I.77891, C.I.47005, and C.I.61570.</div></li></ul>
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<p>Treatment: twice daily for 12 weeks</p>
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<p>Study duration: 12 weeks</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Conventional soap bar</div></li></ul>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Change in inflammatory lesion counts</div></li><li class="half_rhythm"><div>Change in non-inflammatory lesion counts</div></li><li class="half_rhythm"><div>Skin-related adverse events:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">itching</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">redness</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">scaling</p></dd></dl></dl></div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng198er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng198er2.s1.1.ref3" rid="niceng198er2.s1.1.ref3">Santos-Caetano 2019</a>
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</p>
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<p>RCT</p>
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<p>USA</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=122</p>
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<p>Mean age (SD) in intervention groups: 31.7 (7.7) and 31.4 (6.5)</p>
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<p>Mean age (SD) in control group: 32.6 (7.7)</p>
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<p>Female gender (%) in:
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<ul><li class="half_rhythm"><div>4% reformulated BPO wash group: 73</div></li><li class="half_rhythm"><div>10% reformulated BPO wash group: 80</div></li><li class="half_rhythm"><div>10% older formulation BPO group: 78</div></li></ul>
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Facial acne severity: mild to moderate (defined as grade 2 or 3 on the 2005 IGA scale for acne severity suggested by the US Food and Drug Administration)</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Reformulated 4% BPO face wash<sup>1</sup></div></li><li class="half_rhythm"><div>Reformulated 10% BPO face wash<sup>1</sup></div></li></ul>
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<p>Treatment: twice daily for 21 days (+/-2 days)</p>
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<p>Study duration: 21 days (3 weeks)</p>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Older formulation 10% BPO Acne Foaming Wash (no longer commercially available)</div></li></ul>
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</td><td headers="hd_h_niceng198er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Skin-related adverse events:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">burning sensation</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">dryness</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">erythema</p></dd></dl></dl></div></li><li class="half_rhythm"><div>Study product acceptability (satisfied/very satisfied)</div></li></ul>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">BPO: benzoyl peroxide; IGA: Investigator’s Global Assessment; SD: standard deviation; syndet: synthetic detergent</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng198er2.tab2_1"><p class="no_margin">Reformulated products used the sugar-base surfactants sodium laurylglucosides hydroxypropylsulfonate and decyl glucoside instead of potassium lauryl sulphate and sodium lauryl sulphate, and contain a different source of BPO raw material that contains micronized BPO particles.</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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