Further research is urgently needed for effective non-antibiotic treatments for acne, because of concerns regarding long-term antibiotic use and its contribution to bacterial resistance, experts wrote in the journal The Lancet today. Pharmacies are well stocked with a wide range of acne medications. However, evidence regarding their efficacy and which treatments work best for whom are limited, the authors added.

Leading author Hywel Williams from the Centre of Evidence-Based Dermatology at University of Nottingham in Nottingham, UK explains:

"The large number of products and product combinations, and the scarcity of comparative studies, has led to disparate guidelines with few recommendations being evidence-based."

Guidelines, including recent ones and those from the Global Alliance to Improve Outcomes in Acne and the American Academy of Dermatology are solely based on the opinion of experts. This raises concern due to potential conflicts of interest without evidence to support practice recommendations.

Relatively little knowledge exists about causes and treatments of acne, despite the fact, that nearly all young people suffer it to some degree. Even though factors, such as diet, sunlight and skin hygiene have been associated with the condition, there is no supportive evidence.

The authors explain that those suffering from acne could spend a lot of time and effort to change their lifestyles with no success at all.

The seminar revealed that:

"Almost half of recently published acne trials contain serious flaws that could be overcome by better reporting. . . . The absence of trials with active comparators is a significant handicap to shared clinical decision making. Clinical trials of cost-effectiveness of different strategies for initial treatment and maintenance therapy of acne are needed."

The IOM (Institute of Medicine), USA, would like more comparative studies on acne medications and therapies as one of the top 100 targets for national research. The IOM says that the lack of extensive studies makes it difficult for doctors to know what to say for their patients. Patients also risk wasting a lot of time and money on ineffective therapies.

Long-term low-dose antibiotic usage may lead to the proliferation of antibiotic-resistant bacteria. The authors suggest using benzoyl peroxide as an alternative maintenance treatment, which may be equally effective and to restrict the use of antibiotics.

In a concluding statement, the authors emphasize the need for new research into the comparative effectiveness of common topical and systemic therapies and to improve knowledge of the natural history, specific types, and triggers of acne together with how treatment affects the course of this disease which is not well understood.

Written by Petra Rattue