Corcoran Louise, Muller Ingrid, Layton Alison M, Rucinski Gwennan, Venkatess Viktoria, Sufraz Anicka, Dove Sophie, Lown Mark, Stuart Beth, Francis Nick, Santer Miriam
University of Southampton Southampton UK.
Skin Research Centre Hull York Medical School University of York York UK.
Skin Health Dis. 2023 May 23;3(4):e240. doi: 10.1002/ski2.240. eCollection 2023 Aug.
Acne is very common, can cause considerable negative impact on quality of life and there is increasing concern over the use of long courses of oral antibiotics for this condition.
(1) To critically appraise reporting in acne guidelines and compare this with previous systematic review of acne guidelines. (2) Examine acne treatment guidance on pre-specified acne treatments of interest and compare between acne guidelines.
Searches for new or updated guidelines were carried out in MEDLINE, Embase, Google Scholar, LILACS from 1 January 2017 to 31 July 2021, supplemented by searching a guideline-specific depository and checking for updates to guidelines included in previous review. We included guidelines, consensus statements or care protocols on the medical treatment of acne vulgaris in adults and/or children and excluded those that focused on a single intervention or subgroup of acne, regional adaptations of guidelines or guidelines included in previous review. AGREE II checklist was applied to critically appraise reporting of guidelines. Results were synthesised narratively.
Of 807 abstracts identified nine guidelines were identified that were eligible for inclusion. All guidelines had AGREE II scores above average in at least one domain and reporting was substantially improved compared to the systematic review of acne carried out 5 years previously. There was consensus between guidelines on the key role of topical treatments as first-line acne treatment and most recommended continuing topical treatments as maintenance therapy. There was considerable variation between guidelines on classification of severity, indications for commencing oral antibiotics and on maximum duration of oral antibiotics. However, there was consensus on the need for co-prescription of a non-antibiotic topical treatment when using oral antibiotics. There were notable differences on recommendations regarding provision of information for patients on how to use topical treatments or how to mitigate against side effects.
Substantial differences in classification of acne severity hampered comparisons between guidelines. Although development and reporting of guidelines has improved over the past 5 years, differences in key recommendations remain, possibly reflecting uncertainties in the underlying evidence base. Differences between guidelines could have substantial implications for prevalence of antibiotic prescribing for acne.
痤疮非常常见，会对生活质量造成相当大的负面影响，人们越来越关注针对这种情况长期使用口服抗生素的问题。
（1）批判性评价痤疮指南中的报告，并将其与之前对痤疮指南的系统评价进行比较。（2）研究关于感兴趣的预先指定的痤疮治疗方法的痤疮治疗指南，并在痤疮指南之间进行比较。
于2017年1月1日至2021年7月31日在MEDLINE、Embase、谷歌学术、拉丁美洲及加勒比地区卫生科学数据库中检索新的或更新的指南，并通过搜索特定指南的存放库以及检查之前综述中纳入的指南的更新情况进行补充。我们纳入了关于成人和/或儿童寻常痤疮医学治疗的指南、共识声明或护理方案，并排除了那些侧重于单一干预措施或痤疮亚组、指南的区域改编版或之前综述中纳入的指南。应用AGREE II清单对指南报告进行批判性评价。结果进行叙述性综合。
在识别出的807篇摘要中，确定了9篇符合纳入标准的指南。所有指南在至少一个领域的AGREE II评分高于平均水平，与5年前进行的痤疮系统评价相比，报告有了实质性改进。指南之间就局部治疗作为一线痤疮治疗的关键作用以及最推荐将持续局部治疗作为维持治疗达成了共识。在严重程度分类、开始口服抗生素的指征以及口服抗生素的最长疗程方面，指南之间存在相当大的差异。然而，在使用口服抗生素时需要联合开具非抗生素局部治疗药物这一点上达成了共识。在为患者提供关于如何使用局部治疗或如何减轻副作用的信息的建议方面存在显著差异。
痤疮严重程度分类的实质性差异阻碍了指南之间的比较。尽管在过去5年中指南的制定和报告有所改进，但关键建议仍存在差异，这可能反映了基础证据基础中的不确定性。指南之间的差异可能对痤疮抗生素处方的流行率产生重大影响。
