This review highlights clinically important findings about
acne treatment identified in nine systematic reviews published or indexed in the period March 2009 to February 2010. A systematic review of dietary influences on
acne suggested that a possible role of dietary factors in
acne cannot be dismissed, as the studies to date have not been sufficiently large or robust. Another review looked at
benzoyl peroxide, which may be enjoying a comeback because of increasing bacterial resistance to
antibiotics, and suggested that there was a lack of evidence that stronger preparations were more effective than weaker ones. The same team also carried out a systematic review addressing the question of whether topical
retinoids cause an initial worsening of
acne. They found no evidence to suggest initial worsening of
acne severity, although there was evidence of skin irritation that typically settled by 8-12 weeks. A review of oral
isotretinoin and psychiatric side-effects reinforced a possible link between the two, although it pointed out that the better-quality primary studies were still inconclusive. An updated Cochrane Review confirmed the efficacy of
combined oral contraceptives (COCs) in reducing
acne lesion counts. It also found that the evidence to support COCs containing
cyproterone acetate over others was very limited. Another Cochrane Review failed to show any benefit of
spironolactone for
acne, based on limited studies. Three reviews examined
laser and
light therapies, and found some evidence of superiority only for blue or blue/red light treatment over placebo light, but a general absence of comparisons against other
acne treatments.
Photodynamic therapy had consistent benefits over placebo but was associated with significant side-effects and was not shown to be better than topical
adapalene.