There are many products that are publicised as cures for acne, often at considerable expense to both consumers and the health-care system, but there is very little evidence of which ones work best and for whom. Few studies have compared treatments against each other in terms of effectiveness and safety. Furthermore, concerns that the long-term use of antibiotics to treat acne might contribute to bacterial resistance increases the urgency to test treatment regimens and to develop more effective non-antibiotic therapies, according to a Seminar, published Online First in The Lancet.
"The large number of products and product combinations, and the scarcity of comparative studies, has led to disparate guidelines with few recommendations being evidence-based", explains lead author Hywel Williams from the Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK. As a result, even recent guidelines (including those from the Global Alliance to Improve Outcomes in Acne and the American Academy of Dermatology) are based on the opinion of experts. This is of concern because without evidence to support practice recommendations, there is the potential for conflicts of interest.
Although acne affects almost all young people to some degree, relatively little is known about its causes and treatment. Factors such as diet, sunlight, and skin hygiene have all been implicated, but supportive evidence is lacking. Acne suffers could be going to great lengths to change their lifestyles and it might make no difference at all, explain the authors.
According to the Seminar: "Almost half of recently published acne trials contain serious flaws that could be overcome by better reporting…The absence of trials with active comparators is a significant handicap to shared clinical decision making. Clinical trials of cost-effectiveness of different strategies for initial treatment and maintenance therapy of acne are needed."
This lack of well-conducted research to test over-the-counter and prescription therapies is putting patients at risk of ineffective treatment and makes treatment decisions for patients and doctors very difficult. This has prompted the Institute of Medicine in the USA to target comparative-effectiveness research on acne therapy as one of the top 100 targets for national research.
There is also considerable concern that the overuse of antibiotics to treat acne will lead to the development of resistance, especially since they are used for long periods at low doses. The authors suggest restricting the use of antibiotics as maintenance treatment because alternatives such as benzoyl peroxide might work just as well.
The authors conclude by calling for new research into the comparative effectiveness of common topical and systemic therapies and to improve the understanding of the natural history, specific types, and triggers of acne, and how treatment affects the course of this poorly understood disease.
Professor Hywel Williams, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK. T) +44 (0) 115 82 31048 E) hywel.williams@nottingham.ac.uk
Journal
The Lancet