2012 Annual Evidence Update on Acne vulgaris

24 Pages·2013·0.16 MB·English

by  Bryony Elliott

2011 - 2012 Annual Evidence Update on Acne vulgaris
Introduction
Welcometothe sixth Annual Evidence Updateon Acne Vulgaris from the Centreof
Evidence-Based Dermatologyat theUniversityof Nottingham where we search for newUK
national guidelines andsystematicreviews of randomised controlledtrialspublished or
indexed since the last Annual Evidence Update in February2011. Inaddition tocollating
newresources, we also include a "what'snew" analysis, discussing the newevidence and
its implicationsfor clinical practice. Thisupdate isaimed at healthcare professionals, but we
also hope that manypeople who have acne will find at least someof the information
interesting.
Weusesystematicreviews as our core evidencesourcefor Annual Evidence Updates
because of the well-known hazards in interpreting theresults of singleresearch studies, the
resultsof which tend tobe contradictedwith time. (TVPereiraet al). If you want to delve
moredeeplyinto thetopic areas, we recommendthat you readthe original articles and come
to your own decisions about their utility.
In previous years, our annual evidence updates were produced incollaboration with NHS
Evidence-skin disorders, managedbythe National Instituteof Health andClinical Excellence
(NICE). However, NICEhave decided to reorganise thespecialist libraries which has meant
that NHS Evidence-skindisordersand itsannualevidence updates no longer exist.Whilst
one of us(HW) continues towork with NICE as its expert advisor for NHS Evidence
https://www.evidence.nhs.uk/nhs-evidence-content/medicines-information (accessed
August 12th 2013), we have takenthe decision at our Centre of Evidence-Based
Dermatologytotryand continue our updates onacne and eczemaunder our own steam
based onthefantasticfeedback we have hadfrom you, our readers.
2011 – 2012 Annual Evidence Update on Acne Vulgaris – Results
A literature searchwas carried out to identify new guidelinesand systematicreviews
relating toacnevulgaris(common acne) that have been published or indexed since the 2011
Annual Evidence Update on AcneVulgaris.Theresult of this search isthe 2012 Annual
Evidence Update on Acne Vulgaris.
Search period
January2010 was set asthelimit for earliest publication dateinthis year'ssearches, to
allowfor anydelays in indexing of citationsin thebibliographic databasesused (which might
meanthe citationswere not found inthesearchesfor the previous Annual Evidence Update
in February2011).
All the searches were carried out for thelast timeon 22nd August, 2012.
Sources Searched
Thefollowing sourceswere searched:
Ovid MEDLINE (using SIGN MEDLINE systematic reviewfilter)
Ovid EMBASE (using SIGN EMBASE systematic reviewfilter)
PubMed (using PubMed Clinical Queries systematic reviewfilter)
Cochrane Library
NHS Evidence – www.evidence.nhs.uk
All citationsfoundinthesearcheswere hand searched byreading thetitles and abstractsto
identifyguidelines and potential systematicreviews relevant to acnevulgaris. For all
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potential systematicreviews where therewas still somedoubt, thefulltexts were thenread
to ensurethat theywereindeed systematicreviews.
Thedefinition of asystematicreviewfrom theGlossaryof CochraneCollaborationTerms on
the Cochrane Collaboration website was used:
A reviewof aclearlyformulatedquestionthat uses systematic andexplicit methodsto
identify, select, andcriticallyappraise relevant research, andtocollect andanalyse data
from the studiesthat areincluded in thereview. Statistical methods(meta-analysis) mayor
maynot beusedtoanalyse and summarisetheresults of the included studies.
RESULTS
Newguidelines and citationsfor newsystematicreviews judgedof direct relevance to the
topic of acnevulgaris and itstreatment arelistedbelow. Linksto PubMed abstractsorfree
full text, where available, areprovided.
Please notethat theinclusionof citationsinthislist doesnot implyendorsement. We
not accept responsibilityfor the content or qualityof includedstudies.
A large number of citations were identified aspossible systematicreviews for theAnnual
Evidence Update in theinitial searchresults, butwere subsequentlyexcluded onthe
grounds of alack of aclear systematicreviewmethodologyor for other reasons. These
citations are listedat theend of thispage under the heading "Excluded references".
________________________________________________________________________
European Guideline
Nast A, DrénoB, Bettoli V, DegitzK, Erdmann R, FinlayAY, Ganceviciene R, Haedersdal M,
Layton A, López-EstebaranzJL, Ochsendorf F, Oprica C, Rosumeck S, RzanyB, Sammain
A, SimonartT, Veien NK, Zivković MV, Zouboulis CC, Gollnick H; European Dermatology
Forum.
European evidence-based (S3)guidelines for the treatment of acne.
J Eur Acad Dermatol Venereol. 2012Feb;26Suppl 1:1-29.
Link to PubMed abstract
Systematic Reviews
Zhao YE, HuL,WuLP,Ma JX.
A meta-analysis of association between acne vulgaris and Demodexinfestation.
Journal of Zhejiang UniversitySCIENCE B. 13(3):192-202, 2012Mar.
Link to PubMed abstract
Note: MEDLINE andWeb of knowledge searched
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VeithWB, Silverberg NB.
Theassociation of acnevulgaris with diet.
Cutis. 88(2):84-91, 2011Aug.
Link to PubMed abstract
Note: PubMedonly searched.
Dunn LK, O’Neill JL, Feldman SR.
Acne in adolescents:qualityof life, self-esteem,mood andpsychologicaldisorders.
DermatologyOnline Journal. 17(1):1, 2011.
Link to PubMed abstract
Note: Medline only searched
AlharithyR.
Adolescent’s acne: scarring inside out!
Journal of theSaudi Societyof Dermatology&DermatologicSurgery(2011) 15, 43–46.
Link to abstract
Note: Medline, PsychINFO, EMBASE and CINHAL searched.
Crijns HJ, StrausSM, Gispen-deWiedC, de Jong-van denBerg LT.
Compliance with pregnancyprevention programmes of isotretinoin in Europe: asystematic
review
British Journal of Dermatology. 164(2):238-44, 2011 Feb.
Link to PubMed abstract
Note: Medline and EMBASE searched
Shapiro S, Heremans A, Mays DA, Martin AL, Hernandez-Medina M, Lanes S.
Use of topicaltretinoin and thedevelopment of noncutaneousadverse events: evidence
from asystematicreview of theliterature
J Am Acad Dermatol. 2011 Dec;65(6):1194-201.
Link to pubmedabstract
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Note: Medline, embaseand Current Contentsfor relevant studies of anydesign including
case reports searched
Siedler EMand Kimball AB.
Meta-analysis of randomised controlled trials using 5% benzoyl peroxide and clindamycin
versus 2.5% benzoyl peroxide and clindamycin topical treatments inacne.
Journal of theAmericanAcademyof Dermatology. 65(4):e117-9, 2011Oct.
Link to PubMed abstract
Note:L PubMedand FDA summariessearched.
Brandsetter AJ andMaibach HI.
Topical dosejustification: benzoyl peroxide concentrations.
J Dermatolog Treat. 2011 Dec 27.
Link to PubMed abstract
Note: PubMed, Embaseand a sciencecitation indexweresearched.
Mohd Nor NH and AzizZ.
A systematic reviewof benzoyl peroxide for acnevulgaris.
J Dermatolog Treat. 2012 July25
Link to PubMed abstract
Note: Cochrane library,Medline, EBSCohost and PubMed, CINAHL andScience directwas
searched.
GambleR, DunnJ, Dawson A, Petersen B, McLaughlin L, Small A, KindleS, Dellavalle RP.
Topical antimicrobial treatment of acne vulgaris: an evidence-based review.
Am JClin Dermatol. 2012 Jun 1;13(3):141-52.
Link to PubMed abstract
Note: Ovid, MEDLINE, EMBASE and Cochrane librarysearched.
Webster GF.
Evidence-based review: fixed-combinationtherapyand topical retinoids inthetreatment of
acne.
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J DrugsDermatol. 2011Jun;10(6):636-44
Link to PubMed abstract
Note: PubMedonly searched.
PurdyS and deBerker D.
Acne vulgaris.
Clinical evidence, 2011.
Link to PubMed abstract
Note: MEDLINE, EMBASE, theCochranedatabase of systematicreviews, the USfoodand
drug administration (FDA) alerts andtheMedicines and healthcareproducts regulatory
agency (MRHA) were searched.
Ong MW and Bashir SJ.
Fractional laser resurfacingfor acnescars: areview.
British Journal of Dermatology. 166(6):1160-9, 2012 Jun.
Link to PubMed abstract
Note: PubMedand Scopus searched.
Dreno B, FischerTC, Perosino E, Poli F, VieraMS, Rendon MI, BersonDS, Cohen JL,
RobertsWE, StarkerI,Wang B.
Expert opinion: efficacyof superficial chemical peels in active acnemanagement – what can
we learnfrom the literaturetoday? Evidence-based recommendations.
Link to PubMed abstract
Note: PubMedonly searched.
Brown J, Farquhar C, Lee O, Toomath R, JepsonRG.
Spironolactone versus placebo or in combinationwith steroidsfor hirsuitsm/acne.
Cochrane
Link to Cochrane abstract
Garner SE, EadyA, Bennett C, Newton JN, Thomas K, PopescuCM.
Minocycline for acnevulgaris: efficacyandsafety.
Cochrane
Link to Cochrane abstract
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Arowojolu AO, Gallo MF, LopezLM, Grimes DA
Combined oral contraceptive pills for treatment of acne. Cochrane
Link to Cochrane abstract
Excluded references
Zeichner JA
Optimizing topical combination therapyfor thetreatment of acne vulgaris
J DrugsDermatol. 2012Mar;11(3):313-7
Link to pubmedabstract
Note: Nomethodssection and nodetails of systematicsearchstrategy
Gold MH
Photodynamic therapy
Curr Probl Dermatol. 2011;42:181-92
Link to pubmedabstract
Note: Nodetailedmethods sections andno systematicsearch strategy
Szczepaniak D,Treadwell P.
AcneTherapyin primarycare: Comprehensive reviewof current evidencebased
interventions andtreatments.
Adolesc Med State Art Rev. 2011 Apr;22(1):77-96.Link toPubMed abstract
Note: Nosystematic search andincompletemethodology reporting.
Gannon M, Underhill M, Wellik KE.
Clinical enquiries.Whichoral antibiotics are best for acne?
J. Fam. Pract. 2011May;60(5):290-2
Link tofull text
Note: Noclear method described andno systematic search strategy
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Feldman SR,Tan J, Poulin Y, DirschkaT, Kerrouche N, Manna V.
Theefficacyof adapalene-benzoyl peroxide combination increaseswith number of acne
lesions.
J Am Acad Dermatol. 2011 Jun;64(6):1085-91.
Link to pubmedabstract
Note: Nosearch strategy, sounclear howthe 3pooled trials wereidentified andthereforeat
risk of publication bias.
Gold MH
Clindamycin Phosphate 1.2% and Benzoyl Peroxide 2.5% Gelfor theTreatment of Moderate
to severe Acne: An update
TheJournal of Clinical &Aesthetic Deramtology. 5(1):30-5, 2012Jan
Link to pubmedabstract
Note: nomethodologyand no searchstrategy
Williams HC, Dellavalle RP, Garner S.
Acne vulgaris
Lancet. 2012Jan 28;279(9813):361-72
Link to pubmedabstract
Note: systematic searching however themethodsof synthesising evidence was not explicit.
Woolery-Lloyd H, VieraMH, ValinsW.
Laser therapyin black skin.
Facial Plastic SurgeryClinics of NorthAmerica. 19(2):405-16, 2011May
Link to pubmedabstract
Note: Noclear methodology
Pierard-Franchimont C,Paquet P, PierardGE
Newapproaches in light/laser therapies andphotodynamic treatment of acne
Expert Opin Pharmacother. 2011 Mar; 12(4):493-501
Link to pubmedabstract
Note: Noclear method outlined
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Comin AF, de Albuquerque SantosZE
Relationship between diet’sglycemic load andacne. <Relacao entrecargaglicemica da
dieta e acne.>
Scientia Medica. 21(1) (pp37-43), 2011.
Link tofull text
Note: Nomethodology and no details of search inmaintext
Leyden JJ, Del RossoJQ
Oral Antibiotic therapyfor AcneVulgaris. Pharmacokinetic and Pharmacodynamic
perspectives.
J Clin Aesthet Dermatol. 2011 February; 4(2):40-47
Link to pubmedabstract
Note: Noclear method or systematic search
Arora MK, YadavA, SaniV.
Role of hormonesin acne vulgaris.
Clinical Biochemistry. 44(13):1035-40, 2011Sep.
Link to PubMed abstract
Note: Nooutline of methodology and nosystematic searchstrategy.
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2012 Annual Evidence Update on Acne Vulgaris –Commentary
"What's new?" — atour of the2012 Annual Evidence Updateon Acne Vulgariswith
the busyclinicianinmind
Dr KetakiBhate, Academic Clinical Fellow in Dermatology, NottinghamUniversity Hospitals
NHS Trust, andProfessor HywelWilliams, Director of the Centreof Evidence-Based
Dermatology at theUniversityof Nottingham .
What this guideis all about
Our task inthis commentary is toreadthrough allthe newguidelines andsystematicreview
evidence we have foundin the Results section inorder toprovide you with a summaryof
important developmentsin acne researchthat might changeyour practice — either by
stopping something ineffective or harmful, or encouraging you to adopt anewtreatment
approachthatmight bebeneficial. Sometimestheevidence will just reinforce what you do
already, which can alsobe useful if, likeus, youare worriedthat you might bemissing
something newand important.Wealso highlight somemethodological issues in the
published studies.Wehope that youfindsomeof these insightsinteresting, educational and
useful.
Inthe 2011 Annual Evidence Updateon AcneVulgaris (link), wefoundtwoguidelines and
five articlesthatfall within our definition of asystematicreview. Thequalityof those
systematicreviews was rather disappointing, withonly one out of thefivereviews searching
morethanone electronicdatabase. Thecurrent 2012 updateincluded oneguideline and 17
systematicreviews. You will see that we have excluded lots of articlesthatwere initially
pickedup aspossible systematicreviews byour searches, inmost casesdue toan absence
of details of anysystematic reviewmethodologyin thefull articles.
Guidelines
European evidencebased (S3) guidelines for thetreatment of acne
One newguideline was found in our search in 2011 to2012: aguideline in acne composed
bynominated experts from the European DermatologyForum andThe European Academy
of Dermatologyand Venereology working in theacnefield. It isthefirst of itskindstemming
from Europe. Most well known acne therapieswere discussed including topical, systemic
and light basedtherapies andthesetherapies were divided into treatmentsfor comedonal
acne, papulopustular acne and nodular/conglobate acne. Overall, after reviewing theclinical
trialsfound intheir searches theauthors recommended atopical retinoidfor comedonal
acne (but this was not astrong recommendation), adapalene or clindamycin in combination
with benzoyl peroxide topicallyfor mild to moderate papulopustular acneand isotretinoin
orallyfor severe papular-pustular acne, moderatenodular acne or severe
nodular/conglobateacne. Systemic antibioticswere not recommendedfor comedonal acne
and were not strong recommendations for papulopustular or nodular/conglobate acne.
Hormonaltherapies were recommended as an alternative for female patients with
papulopustular/nodular/conglobateacne. Theseguidelines highlight thelack of evidencefor
light based or laser therapies at present particularly with regardto side effect profiles.
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Search criteriawere thoroughand recommendations were agreedin aconsensus bya panel
of experts, andthe strength of recommendationstook intoconsiderationthe level of
evidence the recommendations stemmedfrom; overall making this asturdyguideline which
can berelied upon. Over 300referenceswere included. The onlyaspect that let down this
otherwise thoroughguideline was that potential conflicts of interest of theauthorswere not
declared, andseveral areknown to work for theindustry. Oftenacnetherapybegins in
primarycare bygeneralpractitioners and theintroduction of theseguidelines will be useful
particularlytothoseGPs initiating therapy but also to practising dermatologists dealing with
moresevereforms of acne. They are valid until2015 at which point theyare due tobe
updated.
Systematicreviews
Acne vulgaris andDemodex infestation
Demodexmitesarecolonisers of human skinfound onthe nose, cheeks, forehead, temples,
chin, external ear, scalp and upper chest andprincipally reside aroundsebaceous glands.
Themitehasbeen associated with several otherskinconditions such asrosacea. The
authorsof thismeta-analysis set aboutto collateevidence from case-control studiesto
confirmthe link between demodexinfestation andacne vulgaris. Their search strategydated
back to1950and involved 2 English databases –MEDLINE and Institute of scientific
informationWeb of Knowledge andone Chinesedatabase – China National Knowledge
infrastructure. Thestudyemployed definitive inclusion and exclusion criteria which allowed
them toisolate studies which would be included into ameta-analysis. All in all, 60 Chinese
and just 3 English papers were included in the analysis. A χ2 test was applied to all papers
with 43 of themfinding an association and15, with no association.The pooled odds ratio
(OR) of an associationbetween demodexinfestation and thedevelopment of acne was
significant at 2.80(95%CI 2.34-3.36). Fail safe numberformulaewere applied to reduce
publication bias –this number was 18,477meaning that many papers with negative
conclusions would be requiredbeforetheconclusion that demodexand acne were related
could be doubted. The authors presented dataappropriatelyinforest plotsallowing easy
readability and concluded that acnevulgarisis significantlyrelatedto Demodexinfestation
but not asclosely as therelationship between demodexand rosacea.Overall this isa
thorough systematicreview which indicates surprisinglylargeliteratureondemodexand
acnefrom China. Themain drawback of thereviewis that thereistoomuch emphasison
quantitative meta-analysis without enoughconsideration of therisk of biasassociatedwith
the observational studiesfound. Intermsof affecting our practice however, thesefindings
are unlikelyto influenceour clinical work otherthan letting our patientsknowdemodexmay
be implicatedshould theyask. Thestudiestodate cannot separatecausefrom effect. If
causal, it is unclear whether it isthe demodexordemodex-associatedbacteria at this stage.
This study highlightstheneedfor further studieslooking intomanipulatingdemodexspecies
as atherapeutictarget.
Diet and acne
Thetopic of diet andacne has becomequitecontroversial with an influxof newstudies and
hypotheses over thelast10 years. Theauthorsof this article aimedtosystematically
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