Most teenagers experience at least some degree of acne, and the problem sometime extends into adulthood. When it’s severe (or even when it’s not) it can lead to low self-esteem, depression, and diminished quality of life. Yet despite the scads of prescription and over-the-counter treatments marketed for acne, very little is known about their comparative effectiveness—that is, which of them works best, and for whom, according to a review published today in the journal Lancet.

Researchers at the University of Nottingham in the United Kingdom and other institutions undertook a comprehensive review of the scientific literature on acne causes, treatments, and management dating back to 1999. The treatments they examined included topical ones, such as benzoyl peroxide (Clearasil, On-The-Spot, PanOxyl) and retinoid creams, as well as oral therapies, such as the class of antibiotics known as tetracyclines, oral contraceptives, and isotretinoin (Accutane). While a lot of the treatments work at least sometimes, the authors point out that many of the studies testing them have had methodological flaws, and since there’s been very little research on how the treatments compare to each other, dermatologists have little to go on but expert opinion in deciding which regimens to suggest.

What’s more, according to the authors, the long-term use of antibiotics at low doses to treat acne is troublesome since it might contribute to antibiotic resistance. That makes it all the more urgent to test different treatment regimens and develop better non-antibiotic therapies.

"This lack of well-conducted research to test over-the-counter and prescription therapies is putting patients at risk of ineffective treatment and makes treatment decisions for patients and doctors very difficult,” the authors write. That guesswork also extends to the lifestyle changes that are sometimes recommended for people with acne. For example, patients are sometimes advised to alter their diet or skin-care regimen, yet there’s little published scientific research testing these strategies. So dermatologists and other health care professionals might be raising false hopes and inconveniencing their patients with steps that may have no effect on their acne.

Bottom line: There’s a silver lining in some of this. Acknowledging the lack of good comparative studies to guide acne treatment, the Institute of Medicine has designated comparative-effectiveness research on acne therapy as one of its top 100 targets for national research.

Read more on treating acne and check our advice on how to calm your skin.

Sources
Acne vulgaris [The Lancet]