The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis

Abstract

Background

Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence based support in the efficacy and safety of non-pharmacological therapies is lacking.

Objective

To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.

Methods

A systematic literature review, including a best-evidence synthesis was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017.

Results

Thirty three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified: laser and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction on acne lesions. However, only 7 studies had a high methodologic quality. Based on these 7 trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), IPL (400–700nm and 870 – 1200nm) and the diode laser (1450nm). Initially, conflicting evidence was found for pulsed dye laser (585-595nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient.

Conclusion

Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.

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