Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Eur Acad Dermatol Venereol. 2018 Jul;32(7):1195-1203. doi: 10.1111/jdv.14881. Epub 2018 Mar 6.
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.
To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.
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.
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 in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven 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%), intense pulsed light (400-700 and 870-1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585-595 nm). 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.
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.
寻常痤疮是一种多方面的皮肤疾病，影响全球超过 85%的年轻人。由于抗生素耐药性的发展或不良反应的潜在风险，药物治疗并不总是理想的。非药物治疗可以作为传统治疗的可行替代方案。然而，缺乏非药物治疗在疗效和安全性方面的充分循证支持。
评估几种非药物疗法治疗寻常痤疮的疗效和安全性。
进行了系统的文献综述，包括最佳证据综合，以确定文献。检索了三个电子数据库，以查找 2000 年 1 月至 2017 年 5 月期间发表的研究。
我们的系统综述包括 33 项合格研究。确定了三种主要类型的非药物疗法：激光和光疗法、化学换肤和微针射频。大多数纳入的研究表明痤疮病变明显减少。然而，只有 7 项研究具有较高的方法学质量。基于这 7 项试验，进行了最佳证据综合。发现果酸（10-40%）有很强的证据。氨基酸果酸（20-60%）、强脉冲光（400-700nm 和 870-1200nm）和二极管激光（1450nm）有中度证据。最初，脉冲染料激光（585-595nm）的证据相互矛盾。非药物治疗最常报告的副作用包括红斑、可耐受的疼痛、紫癜、水肿和少数色素沉着过度病例，这些在大多数情况下是轻度和短暂的。
有间接证据表明非药物疗法可治疗寻常痤疮。然而，纳入研究的方法学质量不高，使我们无法就逐步治疗方法得出明确结论。然而，我们的系统综述包括最佳证据综合，确实为产生的结果创造了秩序和结构，为未来的研究迈出了第一步。
