Topical, light-based, and complementary interventions for acne: an overview of systematic reviews

Area of Science:

• Dermatology
• Evidence Synthesis
• Pharmacology

Background:

• Acne vulgaris is a common chronic inflammatory skin disease affecting the pilosebaceous unit.
• It presents with non-inflammatory and inflammatory lesions, impacting quality of life and mental health.
• Acne has a growing global prevalence and can lead to complications like scarring.

Purpose of the Study:

• To synthesize evidence on the efficacy and safety of non-systemic pharmacological and non-pharmacological interventions for acne vulgaris.
• To evaluate treatments for acne vulgaris and related skin complications like scarring.

Main Methods:

• Searched multiple databases (Cochrane, Epistemonikos, MEDLINE, Embase) up to December 2021.
• Included systematic reviews with low risk of bias (ROBIS tool) and assessed evidence certainty using GRADE.
• Extracted data from six eligible reviews covering 40,910 participants for acne and 1316 for acne scars.

Main Results:

• Benzoyl peroxide showed very low-certainty evidence for reducing acne lesion counts versus placebo, with potential for increased adverse events.
• Benzoyl peroxide demonstrated little to no difference compared to adapalene (topical retinoid) or clindamycin (topical antibiotic) for most outcomes.
• Evidence for benzoyl peroxide versus topical retinoids and antibiotics was generally of very low to low certainty, with limited data on specific comparisons and outcomes like quality of life.

Conclusions:

• No high-certainty evidence was found for any topical therapy, phototherapy, or complementary therapy for acne or acne scars.
• Limitations in methodological quality of included trials and systematic reviews hinder definitive conclusions.
• Future research should focus on pooled analysis of emerging drugs and acne complications, addressing the lack of high-quality evidence for topical retinoids and antibiotics.