Complementary therapies for acne vulgaris

109 Pages·2015·1.02 MB·English

Complementary therapies for acne vulgaris (Review)
Cao H, Yang G, Wang Y, Liu JP, SmithCA, Luo H, Liu Y
ThisisareprintofaCochranereview,preparedandmaintainedbyTheCochraneCollaborationandpublishedinTheCochraneLibrary
2015,Issue1
http://www.thecochranelibrary.com
Complementarytherapiesforacnevulgaris(Review)
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 21
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
ADDITIONALTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 106
NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Complementarytherapiesforacnevulgaris(Review) i
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Complementary therapies for acne vulgaris
HuijuanCao1,GuoyanYang1,YuyiWang2,JianPingLiu1,CarolineASmith3,HuiLuo1,YuemingLiu4
1CentreforEvidence-BasedChineseMedicine,BeijingUniversityofChineseMedicine,Beijing,China.2DepartmentofDermatology,
ChongqingMunicipalHospitalofTraditionalChineseMedicine,Chongqing,China.3NationalInstituteofComplementaryMedicine
(NICM),UniversityofWesternSydney,Sydney,Australia.4c/oCochraneSkinGroup,TheUniversityofNottingham,Nottingham,
UK
Contactaddress:JianPingLiu,CentreforEvidence-BasedChineseMedicine,BeijingUniversityofChineseMedicine,Beijing,100029,
[email protected].
Editorialgroup:CochraneSkinGroup.
Publicationstatusanddate:New,publishedinIssue1,2015.
Reviewcontentassessedasup-to-date: 20January2014.
Citation: CaoH,YangG,WangY,LiuJP,SmithCA,LuoH,LiuY.Complementarytherapiesforacnevulgaris.CochraneDatabase
ofSystematicReviews2015,Issue1.Art.No.:CD009436.DOI:10.1002/14651858.CD009436.pub2.
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Acneisachronicskindiseasecharacterisedbyinflamedspotsandblackheadsontheface,neck,back,andchest.Cystsandscarringcan
alsooccur,especiallyinmoreseveredisease.Peoplewithacneoftenturntocomplementaryandalternativemedicine(CAM),suchas
herbalmedicine,acupuncture,anddietarymodifications,becauseoftheirconcernsabouttheadverseeffectsofconventionalmedicines.
However,evidenceforCAMtherapieshasnotbeensystematicallyassessed.
Objectives
Toassesstheeffectsandsafetyofanycomplementarytherapiesinpeoplewithacnevulgaris.
Searchmethods
Wesearchedthefollowingdatabasesfrominceptionupto22January2014:theCochraneSkinGroupSpecialisedRegister,theCochrane
CentralRegisterofControlledTrials(CENTRAL;2014,Issue1),MEDLINE (from1946), Embase(from1974), PsycINFO(from
1806), AMED(from1985), CINAHL(from1981), Scopus (from1966), andanumber of otherdatabases listedintheMethods
sectionofthereview.TheCochraneCAMFieldSpecialisedRegisterwassearcheduptoMay2014.Wealsosearchedfivetrialsregisters
andcheckedthereferencelistsofarticlesforfurtherreferencestorelevanttrials.
Selectioncriteria
Weincludedparallel-grouprandomisedcontrolledtrials(orthefirstphasedataofrandomisedcross-overtrials)ofanykindofCAM,
comparedwithnotreatment,placebo,orotheractivetherapies,inpeoplewithadiagnosisofacnevulgaris.
Datacollectionandanalysis
Threeauthorscollecteddatafromeachincludedtrialandevaluatedthemethodologicalqualityindependently.Theyresolveddisagree-
mentsbydiscussionand,asneeded,arbitrationbyanotherauthor.
Complementarytherapiesforacnevulgaris(Review) 1
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Mainresults
We included 35 studies, with a total of 3227 participants. We evaluatedthemajority as having unclear risk of selection, attrition,
reporting,detection,andotherbiases.Becauseoftheclinicalheterogeneitybetweentrialsandtheincompletedatareporting,wecould
onlyincludefourtrialsintwometa-analyses,withtwotrialsineachmeta-analysis.ThecategoriesofCAMincludedherbalmedicine,
acupuncture,cuppingtherapy,diet,purifiedbeevenom(PBV),andteatreeoil.Apharmaceuticalcompanyfundedonetrial;theother
trialsdidnotreporttheirfundingsources.
Ourmainprimaryoutcomewas’Improvementofclinicalsignsassessedthroughskinlesioncounts’,whichwehavereportedas’Change
ininflammatoryandnon-inflammatorylesioncounts’,’Changeoftotalskinlesioncounts’,’Skinlesionscores’,and’Changeofacne
severityscore’.For’Changeininflammatoryandnon-inflammatorylesioncounts’,wecombined2studiesthatcomparedalow-with
ahigh-glycaemic-loaddiet(LGLD,HGLD)at12weeksandfoundnoclearevidenceofadifferencebetweenthegroupsinchangein
non-inflammatorylesioncounts(meandifference(MD)-3.89,95%confidenceinterval(CI)-10.07to2.29,P=0.10,75participants,
2trials,lowqualityofevidence).However,althoughdatafrom1ofthese2trialsshowedbenefitofLGLDforreducinginflammatory
lesions(MD-7.60,95%CI-13.52to-1.68,43participants,1trial)andtotalskinlesioncounts(MD-8.10,95%CI-14.89to-1.31,
43participants,1trial)forpeoplewithacnevulgaris,dataregardinginflammatoryandtotallesioncountsfromtheotherstudywere
incompleteandunusableinsynthesis.
Datafromasingletrialshowedpotentialbenefitofteatreeoilcomparedwithplaceboinimprovingtotalskinlesioncounts(MD-
7.53,95%CI-10.40to-4.66,60participants,1trial,lowqualityofevidence)andacneseverityscores(MD-5.75,95%CI-9.51to
-1.99,60participants,1trial).Anothertrialshowedpollenbeevenomtobebetterthancontrolinreducingnumbersofskinlesions
(MD-1.17,95%CI-2.06to-0.28,12participants,1trial).
Resultsfromtheother31trialsshowedinconsistenteffectsintermsofwhetheracupuncture,herbalmedicine,orwet-cuppingtherapy
weresuperiortocontrolsinincreasingremissionorreducingskinlesions.
Twenty-sixofthe35includedstudiesreportedadverseeffects;theydidnotreportanysevereadverseevents,butspecificincludedtrials
reportedmildadverseeffectsfromherbalmedicines,wet-cuppingtherapy,andteatreeoilgel.
Thirtytrialsmeasuredtwoofoursecondaryoutcomes,whichwecombinedandexpressedas’Numberofparticipantswithremission’.
Wewereabletocombine 2studies(lowqualityofevidence),whichcomparedZiyinQingganXiaocuoGranuleandtheantibiotic,
minocycline(100mgdaily)(worstcase=riskratio(RR)0.49,95%CI0.09to2.53,2trials,206participantsat4weeks;bestcase
=RR2.82,95%CI0.82to9.06,2trials,206participantsat4weeks),buttherewasnoclearevidenceofadifferencebetweenthe
groups.
Noneoftheincludedstudiesassessed’Psychosocialfunction’.
Twostudiesassessed’Qualityoflife’,andsignificantdifferencesinfavourofthecomplementarytherapywerefoundinbothofthem
on’feelingsofself-worth’(MD1.51,95%CI0.88to2.14,P<0.00001,1trial,70participants;MD1.26,95%CI0.20to2.32,1
trial,46participants)andemotionalfunctionality(MD2.20,95%CI1.75to2.65,P<0.00001,1trial,70participants;MD0.93,
95%CI0.17to1.69,1trial,46participants).
Becauseoflimitationsandconcernsaboutthequalityoftheincludedstudies,wecouldnotdrawarobustconclusionforconsistency,
size,anddirectionofoutcomeeffectsinthisreview.
Authors’conclusions
Thereissomelow-qualityevidencefromsingletrialsthatLGLD,teatreeoil,andbeevenommayreducetotalskinlesionsinacne
vulgaris,butthereisalackofevidencefromthecurrentreviewtosupporttheuseofotherCAMs,suchasherbalmedicine,acupuncture,
orwet-cuppingtherapy,forthetreatmentofthiscondition.Thereisapotentialforadverseeffectsfromherbalmedicines;however,
futurestudiesneedtoassessthesafetyofalloftheseCAMtherapies.Methodologicalandreportingqualitylimitationsintheincluded
studiesweakenedanyevidence.Futurestudiesshouldbedesignedtoensurelowriskofbiasandmeetcurrentreportingstandardsfor
clinicaltrials.
PLAIN LANGUAGE SUMMARY
Complementarytherapiesforacnevulgaris
Complementarytherapiesforacnevulgaris(Review) 2
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Background
Acneisachronicskindisease,whichcausesspotstooccursimultaneouslyonseveralareasofthebody,includingtheface,neck,back,
andchest.Besidesthecurrentcommonlyusedtreatments,complementaryandalternativemedicines(CAM)areofincreasinginterest
topeoplewhooftenusetheminadditiontoconventionaltreatmentsasadditiveorsingletherapiestotreatacne.
Thereviewquestion
Cananycomplementarytherapiesimprovetheclinicalsymptomsofacnevulgaris?
Studycharacteristics
Wesearchedrelevantdatabasesandtrialsregistersupto22January2014.Weidentified35randomisedcontrolledtrials,with3227
participants,whichused6kindsofCAM(herbalmedicine,acupuncture,wetcupping,diet,purifiedbeevenom,andteatreeoil).A
pharmaceuticalcompanyfundedonetrial;theothertrialsdidnotreporttheirfundingsources.
Keyresults
Forourprimaryoutcome,wecombinedtwostudiesthatcomparedalow-withahigh-glycaemic-loaddiet(LGLD,HGLD),butfound
noclearevidenceofadifferencebetweenthe2groupsat12weeksforachangeinnon-inflammatorylesioncounts.Onlyoneofthese
twotrialsprovidedusabledatatoshowpotentialbenefitofLGLDforreducinginflammatoryandtotalskinlesioncounts.Teatreeoil
andpollenbeevenomwerefoundtoreducetotalskinlesioncountsinsingletrials,respectively.Theremaining31includedtrialsgave
mixedresultsaboutwhethercomplementarytherapiesmightreducethetotalnumberofskinlesioncounts.
Twenty-six trialsreportedadverse events. The herbalmedicine group found some mildside-effects,such as nausea, diarrhoea, and
stomachupset.Theacupuncturegroupfoundsomeitchorrednessandpainfollowingneedleinsertion.Participantswhousedteatree
oilreporteditchiness,dryness,andflakingoftheskin.Noneofthetrialsreportedsevereadverseeffects.
Foroursecondaryoutcome,therewasnoclearevidenceofadifferenceinthenumberofparticipantswithremissionbetweenZiyin
QingganXiaocuoGranuleandminocyclineaccordingtoameta-analysisoftwostudies.
Qualityoftheevidence
Thereissomelow-qualityevidencefromsingletrialsthatalow-glycaemic-loaddiet,teatreeoil,andbeevenommayreduceskinlesions
inacnevulgaris,butthereisalackofevidencefromthecurrentreviewtosupporttheuseofotherCAMs.Methodologicalandreporting
qualitylimitationsintheincludedstudiesweakenedanyevidence.
Complementarytherapiesforacnevulgaris(Review) 3
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CoCo SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
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Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.
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BACKGROUND stitutesofHealth(Workshop1992).Accordingtothisclassifica-
tion,complementarytherapiesaredividedintothefollowingcat-
PleaseseetheglossaryinTable1foranexplanationoftheterms
egories: diet and nutrition (e.g., macrobiotics, Gerson diet, an-
wehaveused.
tioxidants); mind-body interventions (e.g.,meditation, imagery,
hypnosis,supportgroups);bioelectromagnetics(e.g.,electromag-
netics, electroacupuncture); traditional and folk remedies (e.g.,
Descriptionofthecondition
naturopathy,Ayurveda,TraditionalChineseMedicine,homeopa-
Acneisachronicinflammatorycondition.Itmostcommonlyaf- thy);pharmacologicalandbiologicaltreatments(e.g.,antineoplas-
fectsareaswherethesebaceousglandsarelargestandmostabun- ton,chelationtherapy,immuno-augmentationtherapy,sharkcar-
dant-forexample,theface,anteriortrunk,andupperback(Simon tilage);manualhealingmethods(e.g.,massage,chiropractic,ther-
2005).Itisaskindiseasethatcausesspotstooccursimultaneously apeutictouch);andherbalmedicine.
onseveralareasofthebody,includingtheface,neck,back,and Complementaryandalternativemedicinesareasignificantsubset
chest.Comedones, alsoknown asblackheads,which aredilated ofhealthcarepracticesnotintegraltoconventional westerncare
poreswithaplugofkeratin,characterisemildacne.Whiteheads butusedbypeopleintheirhealthcaredecisions (Lewith 2001).
(small,cream-coloured,dome-shapedpapules),redpapules,pus- Thoughlackingbiomedicalexplanation,someofthem(physical
tules,orcystsmaybefoundwithmoderateorsevereacne.Scars, therapies, diet, acupuncture) have become widely accepted, but
both those on the skin and emotional scars, can last a lifetime others,suchasthoseinterventionslinkedtothetheoryofhumours
(Oberemok2002a;Webster2002). (anoldtermtodescribeliquidswithinthebody-anexampleof
Acneisacommonconditionaffecting80%ofadolescents(most whichwasthe’letting’ofbloodasaformoftreatment)andradium
commonlyfrom12yearsofage),butitmayalsoaffect54%of therapy,quietlyfadeaway(Lewith2001).
adult women and 40% of adult men (including those in their TradtionalChineseMedicine(TCM),atraditionalhealthcaresys-
early-ormid-20s)(Ramos-e-Silva2009).Twosurveyssuggestthat temthatisbasedonthebeliefsandpracticesofChineseculture
theageof onsetofacne hasfallen,withameanageof onsetof andancientphilosophy,includesherbalmedicine;acupunctureor
11.6yearsfromasurveyperiodbetween2006to2008andamean moxibustion (combustion of themoxaor mugwort herb);mas-
age of 11.92 yearsfromasurvey period between1991 to1993 sage;cuppingtherapy;therapeuticexercise,suchastaichi;anddi-
(Sørensen2010). etarytherapy.TraditionalChineseMedicineisoneofthemostim-
Bacterialcolonisation,sebum,hormoneproduction,follicularhy- portantcomponentsofcomplementaryandalternativemedicines.
perkeratinisations, andinflammation allcontribute toacnecau-
sation(Friedlander2010).Accordingtothelesiontype,acnecan
beclassifiedintofourmaincategories:non-inflammatory(purely Howtheinterventionmightwork
comedoneacne),mildpapular,scarringpapular,andnodular;the
Acnedevelopsasaresultofincreasedsebumproduction,hyperk-
latter three are inflammatory acne lesions (Webster 2002). Be-
eratinisation,increaseinPropionibacteriumacnes,andinflamma-
sidestheobviousskinlesions,acnemayproducepermanentscar-
tion(Spencer2009),andtreatmentsaimtoaddresssomeorallof
ringandhavesignificantpsychosocialconsequences(Fried2010;
theseelements(Webster2002).
Oberemok2002).
Chinese herbal medicine, manual healing therapies (such as
acupunctureandmassage),andothertraditionalandfolkremedies
mayfollowsimilarmechanismsinthetreatmentofacne.Accord-
Descriptionoftheintervention
ingtothetheoryofTraditionalChineseMedicine,severalfactors
Acnetreatmentaimstolessentheinflammatoryornon-inflamma- maycauseacne,includingthefollowing:overheatingofthelung
toryacnelesions,improveappearance,preventorminimisepoten- orstomach,dampandheattoxinwithbloodstasis,andstagnation
tialadverseeffects,andminimiseanyscarring(Oberemok2002a). ofQi(thelifeforce,orvitalenergy,ofalivingthing)andblood.
Ignoringprescribeddrugs,manypeoplestillrelyonherbalmedi- Astheconditionbecomesprotracted,heatmayriseandlodgein
cations,skinhygieneroutines,anddietarymodifications(Webster theskinandtissues,thus,producingthelesions(Shen1995).All
2002). oftheabovetherapiesmayhelpthebodytoregulatetheQiand
Complementary and alternative medicine (CAM) usually refers blood,eliminatedampness,relieveheattoxicity,andenhancethe
totherapiesthatareusedinadditiontoconventionaltreatment, immunologic function to improve the remission of acne (Shen
andmanysuchtherapiesremainunproven(Verhoef1999).’Com- 1995).Somestudiesalsomentionthatacupuncturecanstimulate
plementary therapy’ is usually used in addition to conventional and balance androgen levelsto inhibit the over-secretion of the
treatments, while ’alternative therapy’ is often used instead of sebaceousgland(Li2009).
conventional treatment. In 1992, the US Office of Alternative Itisusuallyrecommendedthatpeoplewithacnerestricttheircon-
Medicine classified complementary therapies, using the classifi- sumption ofchocolate andoilyorfattyfoods (El-Akawi2006).
cationestablishedbycongressional mandate attheNational In- One review concluded that some components of western diets,
Complementarytherapiesforacnevulgaris(Review) 6
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
particularlydairyproducts,maybeassociatedwithanincreased included23trialsoftopicalandoralCAMtotreatacne.
riskofacne(Spencer2009).Someresearchershaveconcludedthat
geneticpredispositionandhormonalinfluencesplayamoreim-
portantroleinacnethandiet(Magin2005;Wolf2004).How- Whyitisimportanttodothisreview
ever,despitethegeneticregulationofsebumexcretionandother
Despite the widespread use of complementary and alternative
determinantsofacne,dietmayactasamodifierofgeneexpression
medicines(CAM),thereisnosystematicreviewcomprehensively
thatmayaccountfortheincreasedacnerisk(Walton1988).The
assessing theevidenceofCAM.Inparticular,apublication bias
effectofotherkindsofcomplementarytherapiesandmedicines
existswiththeinclusionofEnglish-languagetextsonly.Thereisa
ontreatingacnearecurrentlyunclearduetoinsufficientevidence.
needtoundertakeacomprehensiveandsystematicreviewofthe
Commonlyusedtreatmentsaimtoreducethenumberofinflam-
effectivenessandsafetyofCAMforthetreatmentofacne.
matorylesions,inhibitcomedones(Webster2002),suppressthe
growth of Propionibacterium acne (Toyoda 1998), or reduce se-
baceousglandsizeandsecretoryactivity (Enders2003).Topical
retinoids (such as tretinoin, adapalene, or tazarotene) can usu-
allyinhibitcomedonalacne,thenon-inflammatorytypeofacne. OBJECTIVES
Thesemedications mayreduce thenumber of inflammatory le-
Toassesstheeffectsandsafetyofanycomplementarytherapiesin
sions, butlocalirritation canaccompany them(Webster2002).
peoplewithacnevulgaris.
Benzoylperoxide(BP)aloneorcombinedwitheitherclindamycin
orretinoid,whichexertasynergisticandantimicrobialeffect,can
treatmildpapulopustularacne.Oralantibiotics(Simonart2005)
arealsousedtosuppressthegrowthofacneandreducethepro- METHODS
ductionofinflammatoryfactors(Toyoda1998),whileoraldoxy-
cycline(Garner2009)orminocyclineplustopicalretinoidcanbe
usedintreatingseverepapulopustularornodularacne.Although Criteriaforconsideringstudiesforthisreview
isotretinoin (optimal dosage 0.5 to 1 mg/kg/day) (Katsambas
2004)maybeeffectiveinreducingsebaceousglandsizeandsecre-
toryactivity,decreasingcomedoneformation,andreducingfollic- Typesofstudies
ularcolonisationwithacne(Enders2003),itsteratogenicityand
We included parallel-group randomised controlledtrials (RCT)
adverseeffectsprofile(suchasdryskin,hyperlipidaemia,andpro-
andonlythefirstphasedataofrandomisedcross-overtrialsinany
posedincreasedriskofdepression)isaconcern(Marqueling2007;
dataanalysis.
Webster2002).
Because of theinadequate treatmentresponse or potential side-
effectsof currenttopical treatmentsforacne,thereisincreasing Typesofparticipants
interestintheuseofcomplementarytherapiesasadjuvantorsin- Weassessedparticipantsofanyageandgenderwithadiagnosisof
gle therapies alone. In America, 9% of people reported having acnevulgarisorpapulopustular,inflammatory,juvenile,orpoly-
skinconditionsinthepast12months,7%reportedthattheyhad morphicacne.
usedacomplementarymedicine,and2%reportedseeingacom-
plementarymedicinepractitioner fortheircondition (Eisenberg
Typesofinterventions
1998).
TraditionalChineseMedicinehasbeenwidelyusedtotreatacne Eligibleinterventionsincludedanykindofcomplementaryandal-
formanyyears.Herbalmedicine,includingdecoctionandpatent ternativemedicine,includingdietandnutrition;mind-bodyinter-
medicine,isusedbasedonadiagnosis fromaTCMperspective ventions;bioelectromagnetics;traditionalandfolkremedies;bio-
accordingtothedifferentsyndromesofacne(Shen1995). logicaltreatments;manualhealingmethods;andherbalmedicine,
Althoughtherearenosystematicreviewsofherbalmedicinefor comparedwithnotreatment;placebo;orotheractivetherapies.
thetreatmentofacne,therehasbeenasystematicsummaryofthe ComparisonsincludedacombinationofCAMplusotherthera-
therapeuticeffectofherbalmedicineforthetreatmentofbacterial piesversusotheractivetherapiesalone.
infections(Martin2003),wheretheauthorsfoundsimilarresults
tothoseforconventionaltreatments.Anotherevaluationassessed
Typesofoutcomemeasures
17TCMrandomisedcontrolledtrials(RCTs)(Li2009),andthe
According to the report of the Consensus Conference on Acne
findingsfromtheanalysissuggestedacupunctureandmoxibustion
Classification 1990 (Pochi 1991), the evaluation of lesions and
werebetterthanroutinewesternmedicineatreducingsymptoms
their complications are important to assess theseverity of acne.
ofacne.Asystematicreviewwasconducted(Magin2006),which
Psychosocialimpact,failuretorespondtoprevioustherapies,and
Complementarytherapiesforacnevulgaris(Review) 7
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
occupationaldisabilityarethreeadditionalfactorsusedingrading • AMED(AlliedandComplementaryMedicineDatabase,
acne(Pochi1991). from1985)usingthestrategyinAppendix6;
Thefollowingweretimingofoutcomeswheredatawereavailable: • CINAHL(CumulativeIndextoNursingandAlliedHealth
• short-termdata-datacollectedwithin30daysafter Literature,from1981)usingthestrategyinAppendix7;and
randomisation; • PubMed(from1966)usingtheCAMsubsetandthe
• medium-termdata-datacollectedbetween31and90days strategyinAppendix8.
afterrandomisation;and
Wesearchedthefollowingdatabasesupto20January2014:
• long-termdata-datacollected90daysafterrandomisation.
• Scopus(from1966tothepresent);
• ScienceDirect(frominceptiontothepresent);
Primaryoutcomes • MDConsult(frominceptiontothepresent);
• BioMedCentral(from1997tothepresent);
1. Improvementofclinicalsignsassessedthroughskinlesion
• CurrentContentsConnect®(from1998tothepresent);
counts(totalofinflamedandnon-inflamedcountedseparately)
and
andacneseverityscores.
• ProQuestHealthandMedicalComplete(frominceptionto
2. Adverseeffectsassessedbyreportingearlystudy
thepresent).
discontinuations,theworseningofacneinparticipants,and
otheradverseeventsduringthetreatmentandfollow-upperiod. WealsosearchedthefollowingChinesedatabasesupto24January
2014:
• ChinaNationalKnowledgeInfrastructure(CNKI,from
Secondaryoutcomes
1979tothepresent);
1. Physicians’globalevaluation(aftertreatment). • VIPJournalIntegrationPlatform(VJIP,from1989tothe
2. Participants’selfassessmentofchangeinspecifictypesof present);
lesion(suchascomedones,papules,pustules,ornodules). • WanfangDataChinesedatabases(from1985tothe
3. Psychosocialfunctionoutcomes(suchastheHamilton present);and
DepressionRatingScale(HAMD)). • ChineseBiomedicalLiteraturedatabase(CBM,from1978
4. Qualityoflife(QoL). tothepresent).
WecombinedthePhysicians’globalevaluationandParticipants’
Wesearchedthefollowingdatabaseupto21May2014:
selfassessmentofchangeinspecifictypesoflesionandexpressed
• theCochraneCAMFieldSpecialisedRegisterusingthe
themasthe’Numberofparticipantswithremission’asthishada
searchterm’acne’.
cleardefinitionandwaseasytoassess.Theword“remission”was
defined according to the “Guiding principle of clinical research
on new drugs of traditional Chinese medicine” (Zheng 2002), Searchingotherresources
whichmeanslesionstotallyfaded(or>95%faded)andonlymild
Wesearchedthefollowingtrialsregistersupto24January2014:
pigmentationandscarsremaining.
• ThemetaRegisterofControlledTrials(www.controlled-
trials.com).
• TheUSNationalInstitutesofHealthOngoingTrials
Searchmethodsforidentificationofstudies Register(www.clinicaltrials.gov).
• TheAustralianNewZealandClinicalTrialsRegistry(
We aimed to identify all relevant randomised controlled trials
www.anzctr.org.au).
(RCTs) regardless of language or publication status (published,
• TheWorldHealthOrganizationInternationalClinical
unpublished,inpress,orinprogress).
TrialsRegistryplatform(www.who.int/trialsearch).
• CenterWatch(www.centerwatch.com/).
Electronicsearches
We also searched unpublished postgraduate theses in Chinese
Wesearchedthefollowingdatabasesupto22January2014: databases.
• theCochraneSkinGroupSpecialisedRegisterusingthe Wehandsearchedthereferencelistsofallrelevantarticlesfound
strategyinAppendix1; electronicallyforfurtherreferencestorelevanttrials.
• theCochraneCentralRegisterofControlledTrials
(CENTRAL)inTheCochraneLibrary(2014,Issue1),usingthe
Adverseeffects
searchstrategyinAppendix2;
• MEDLINE(from1946)usingthestrategyinAppendix3; We did not perform a separate search for adverse effectsof the
• Embase(from1974)usingthestrategyinAppendix4; target interventions. We examined data on adverse effectsfrom
• PsycINFO(from1806)usingthestrategyinAppendix5; theincludedstudiesonly.
Complementarytherapiesforacnevulgaris(Review) 8
Copyright©2015TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.