After a half-century of looking at everything from Accutane to zinc, dermatologists still can't prove which acne treatments and drugs work best, a team at Johns Hopkins Children's Center finds after combing the scientific literature.
"One of the key questions for dermatologists has been, How should we be treating acne in any given case?" says pediatrician and medical informatics specialist Harold Lehmann. "Here we are in the 21st century, and we still don't have a clear answer to that question."
Lehmann and his co-authors document the dilemma in a so-called evidence report for the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality. The reports are designed to give the public state-of-the-science information about important health topics.
AHRQ asked Hopkins to analyze the relevant scientific literature and identify the best drugs for treating acne and to determine the strength of acne research findings based on predetermined criteria. The team selected 250 English-language studies that compared 150 acne drugs to each other or to a placebo.
Each study was categorized and rated according to details of how the study was performed, including how patients' acne was assessed and if statistical significance was achieved in each experimental comparison. After rating all the studies, the research team found only 14 of the studies met their criteria for a high "level of evidence," while the other 236 studies were almost equally divided between middle and low levels of evidence based on the group's criteria. "Some of the medicines in the studies we looked at seemed to work quite well," Lehmann says. "But it was impossible to say which medicines were the best for a specific acne condition."
Lehmann suggests that a lack of research standards and a deficiency of studies comparing drugs directly to each other might be to blame for the lack of consensus on best acne therapies.
"Dermatologists know a lot about acne," Lehmann says, "but without standards and guidelines for dermatological research, it's extremely hard to compare one study to another and learn which treatments are best."
Lehmann will work with members of the American Association of Pediatrics and the American Dermatological Society in May to create research standards and guidelines dermatologists can follow to help build consensus on favored acne treatments.
Funding for the report was provided by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality. Other Hopkins researchers contributing to the report were John Andrews, Karen Robinson, Victoria Holloway and Steven Goodman.