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Acne vulgaris - Management
Basis for recommendation
Advice on hygiene measures
Over-the-counter (OTC) treatments
- Most OTC products are not recommended because there is a lack of evidence from clinical trials to support their efficacy [Sharpe, 1995; Brown and Shalita, 1998; Ravenscroft, 2005; Strauss et al, 2007].
- Salicylic acid is a common ingredient in OTC acne treatments. It is a keratolytic drug that has some anti-comedone activity, but there is a lack of evidence from controlled trials to confirm this, and it is considered less effective than the topical retinoids.
- Abrasives (such as aluminium oxide) and sulphur (available combined with resorcinol, as Eskamel®) have been used historically, but lack evidence from controlled trials. Some products containing aluminium oxide are abrasive and can irritate inflamed skin.
- Nicotinamide (available as Nicam®) has been reported as being as effective as topical clindamycin in open-label cohort studies [Dos et al, 2003; Sardesai and Kambli, 2003], but CKS identified no randomized controlled trials to confirm this.
- However, there is substantial placebo-controlled trial evidence to support the use of benzoyl peroxide in the treatment of acne.
Complementary and alternative medicine (CAM)
- There is little evidence to support the use of CAM in the treatment of acne.
- A review of CAM treatments for acne found an overall lack of good quality evidence of beneficial effect; studies were limited in number and most were methodologically poor or underpowered [Magin et al, 2006].
- One systematic review (search date: October 2002) found two trials that investigated the efficacy of herbal remedies in acne [Martin and Ernst, 2003]. Both studies were small and of poor methodological quality.
- One trial compared tea tree oil with benzoyl peroxide. There was no placebo group and the study lacked the statistical power to show equivalence or superiority of the regimens.
- In the other trial, the herb Ocimum gratissimum (dissolved in alcohol and added to oil) was compared with benzoyl peroxide and placebo. However, as various concentrations were investigated, the groups were too small to allow any firm conclusions.
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