Topical treatments for mild‐to‐moderate acne

Linked article: Stuart et al . Br J Dermatol 2021; 185:512–525. Acne is very common in teenagers but also affects many adults. The impact on quality of life and self‐confidence can be great. Mild‐to‐moderate acne is treated with creams, gels or lotions (topical treatments). There is little evidence about how these treatments compare with one another. This makes it difficult for patients and doctors to know which treatments to use. We examined all existing clinical trials on the most commonly prescribed acne topical treatments for patients with mild‐to‐moderate acne to see whether they differed in terms of effectiveness and adverse events. We searched for all published trials using international databases and combined the information from these trials. We compared what the patients told us was most important to them, their own assessment of what they considered to be improvement in their acne, and also looked at patients having to withdraw from the trial or stop treatment because of side‐effects. We found 40 trials with over 18,000 participants. Only 11 trials had a patient reported outcome and 35 assessed side‐effects. All topical treatments were more effective than no treatment and using combined treatment of adapalene plus BPO (benzoyl peroxide) was the most effective. Topical treatments containing antibiotics were not more effective than those without antibiotics. Withdrawal from trials because of side‐effects was uncommon, but seemed slightly more common with use of adapalene plus BPO than with either adapalene or BPO used alone.