痤疮的局部干预、光照干预和辅助干预:系统综述。

IF 8.8 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Yi Yuan, Yiying Wang, Jun Xia, Haibo Liu, Jian Ping Liu, Duoduo Li, Ruiting Wang, Hong Sang, Huijuan Cao
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Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.</p><p><strong>Authors' conclusions: </strong>This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":null,"pages":null},"PeriodicalIF":8.8000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497561/pdf/","citationCount":"0","resultStr":"{\"title\":\"Topical, light-based, and complementary interventions for acne: an overview of systematic reviews.\",\"authors\":\"Yi Yuan, Yiying Wang, Jun Xia, Haibo Liu, Jian Ping Liu, Duoduo Li, Ruiting Wang, Hong Sang, Huijuan Cao\",\"doi\":\"10.1002/14651858.CD014918.pub2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). 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引用次数: 0

摘要

背景:痤疮是一种由免疫介导的皮脂腺单位(由毛囊和相关皮脂腺组成的皮肤结构)慢性炎症性疾病。其特征是非炎症性皮损(开放性和闭合性粉刺)和炎症性皮损(丘疹、脓疱、结节和囊肿)。皮损可出现在面部、胸部和背部,严重程度不一。痤疮呈全球性分布,发病率越来越高。最常见的是寻常痤疮。痤疮会引起疤痕等并发症,严重影响人的心理健康,尤其是严重的痤疮患者。痤疮对患者的生活质量和自尊心有很大影响:综合非系统药物干预和非药物干预(物理疗法和辅助疗法)治疗寻常型痤疮及相关皮肤并发症的有效性和安全性的现有证据:我们检索了截至 2021 年 12 月 2 日的 Cochrane 系统综述数据库、Epistemonikos、MEDLINE 和 Embase,并检查了纳入综述的参考文献列表。至少有两名作者负责筛选、数据提取和批判性评价。根据 ROBIS 工具的评估,我们排除了偏倚风险较高的综述。我们根据 GRADE 对证据的整体确定性进行了评估(由纳入综述的作者或我们自己进行)。我们提供了综述数据中的综合证据,包括研究结果摘要表、结果摘要表和证据图:我们共检索并评估了 733 条记录,但只有六篇偏倚风险较低的综述(五篇 Cochrane 综述和一篇非 Cochrane 综述)符合综述纳入标准。这六篇综述涉及 275 项试验中的 40,910 名痤疮患者和 37 项试验中的 1316 名痤疮疤痕患者。参与者的年龄从 10 岁到 59 岁不等,平均年龄为 9.8 岁到 30 岁。四篇综述包括仅有女性参与者的原始试验,三篇综述包括仅有男性参与者的原始试验。临床重要比较的主要结果:过氧化苯甲酰与安慰剂或无治疗相比:在两项涉及1012名参与者、为期12周的试验中,与安慰剂(长期治疗)相比,过氧化苯甲酰可减少总病变数(平均差(MD)-16.14,95%置信区间(CI)-26.51至-5.78)、炎症性病变数(MD-6.12,95%置信区间(CI)-11.02至-1.22)和非炎症性病变数(MD-9.69,95%置信区间(CI)-15.08至-4.29),但证据非常不确定(确定性极低的证据)。包括1073名参与者(时间点:10周和12周)的两项试验表明,与安慰剂(长期治疗)相比,过氧化苯甲酰对改善参与者的总体自我评估可能几乎没有影响,但证据非常不确定(风险比(RR)为1.44,95% CI为0.94至2.22;确定性极低的证据)。确定性极低的证据表明,与安慰剂相比,过氧化苯甲酰可能会改善研究者的总体评估(RR 1.77,95% CI 1.37 至 2.28;6 项试验,4110 名参与者,长期治疗(12 周))。与安慰剂(长期治疗)相比,包括4287名参与者在内的13项为期10至12周的试验表明,过氧化苯甲酰可能会增加较轻不良事件的风险,但证据非常不确定(RR为1.46,95% CI为1.01至2.11;确定性极低的证据)。过氧化苯甲酰与局部维甲酸:与阿达帕林(长期治疗)相比,过氧化苯甲酰可能会增加皮损总数变化的百分比,但证据非常不确定(MD 10.8,95% CI 3.38 至 18.22;1 项试验,205 名参与者,12 周;极低确定性证据)。与阿达帕林相比,过氧化苯甲酰可能对以下结果(长期治疗)几乎没有影响:炎性病变计数的百分比变化(MD -7.7,95% CI -16.46 to 1.06;1 项试验,142 名参与者,11 周;极低确定性证据)、非炎性病变计数百分比变化(MD -3.9,95% CI -13.31 至 5.51;1 项试验,142 名参与者,11 周;极低确定性证据)、参与者的总体自我评估(RR 0.96,95% CI 0.86 至 1.06;4 项试验,1123 名参与者,11 至 12 周;低确定性证据)、研究人员的总体评估(RR 1.16,95% CI 0.98 至 1.37;3 项试验,1965 名参与者,12 周;低确定性证据)以及较轻不良事件的发生率(RR 0.77,95% CI 0.48 至 1.25,1573 名参与者,5 项试验,11 至 12 周;极低确定性证据)。过氧化苯甲酰与局部抗生素:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Topical, light-based, and complementary interventions for acne: an overview of systematic reviews.

Background: Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). It is characterised by non-inflammatory lesions (open and closed comedones) and inflammatory lesions (papules, pustules, nodules, and cysts). Lesions may be present on the face, thorax, and back, with variable severity. Acne exhibits a global distribution and has a growing prevalence. Acne vulgaris is the most common form. Acne gives rise to complications such as scars and can seriously affect people's mental health, especially those with severe acne. Acne has a huge impact on the quality of life and self-esteem of those affected.

Objectives: To synthesise the existing evidence on the efficacy and safety of non-systemic pharmacological interventions and non-pharmacological interventions (physical therapy and complementary therapies) in the treatment of acne vulgaris and related skin complications.

Methods: We searched the Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE, and Embase to 2 December 2021, and checked the reference lists of included reviews. At least two authors were responsible for screening, data extraction, and critical appraisal. We excluded reviews with high risk of bias as assessed with the ROBIS tool. We evaluated the overall certainty of the evidence according to GRADE (as carried out by the authors of the included reviews or ourselves). We provide comprehensive evidence from the review data, including summary of findings tables, summary of results tables, and evidence maps.

Main results: We retrieved and assessed a total of 733 records; however, only six reviews (five Cochrane reviews and one non-Cochrane review) with low risk of bias met the overview inclusion criteria. The six reviews involved 40,910 people with acne from 275 trials and 1316 people with acne scars from 37 trials. The age of the participants ranged from 10 to 59 years, with an average age range from 9.8 to 30 years. Four reviews included original trials involving only female participants and three reviews included original trials with only male participants. Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.

Authors' conclusions: This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.

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来源期刊
CiteScore
10.60
自引率
2.40%
发文量
173
审稿时长
1-2 weeks
期刊介绍: The Cochrane Database of Systematic Reviews (CDSR) stands as the premier database for systematic reviews in healthcare. It comprises Cochrane Reviews, along with protocols for these reviews, editorials, and supplements. Owned and operated by Cochrane, a worldwide independent network of healthcare stakeholders, the CDSR (ISSN 1469-493X) encompasses a broad spectrum of health-related topics, including health services.
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