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Lots Of Acne Treatments, But Scant Evidence For Which Ones To Choose

Nearly all teenagers get acne at some point, usually after puberty switches their oil glands into high gear. (iStockphoto.com)

Acne can be the bane of a teenager's (or adult's) existence when it flares its unsightly little head. And though pharmacies are full of skin remedies that claim to keep pimples under control, researchers say there isn't much hard evidence on which ones actually work best.

The lack of comparative data means dermatologists could be prescribing the wrong treatments to some patients. And in a worse-case scenario, they could be prescribing antibiotics for too long, leading bacteria to become resistant to the drugs.

Some of the most common treatments for acne include creams and serums for the skin, such as benzoyl peroxide and retinoids. Antibiotics, either alone or in combination with other remedies, have also been shown to work.

"Plenty of products out there compared against placebo (i.e., they work), but much less is known about how well these products, or combinations of these products, compare against each other, and how long they should be used for," Hywel Williams, director of the Centre of Evidence-Based Dermatology at the University of Nottingham in the U.K., told Shots in an email. He co-authored a paper on acne treatments published online this week in The Lancet.

Nearly all teenagers get acne at some point, usually after puberty switches their oil glands into high gear. But exactly what triggers acne is unclear, Williams and his colleagues say. Many believe that a greasy diet or chocolate can bring it on, but there isn't much evidence for that. There more solid support for links to the menstrual cycle, picking and emotional stress.

Experts are also unsure why some treatments work, which means dermatologists have to make the best guess among dozens of options of what to suggest to each patient. Many of the studies comparing products are reported poorly with crucial missing bits of information and errors of interpretation, Williams says. That was one reason the U.S. Institute of Medicine has said that figuring out which acne therapies are most effective should be one of the top 100 targets for national research.

Does this mean that dermatology is somehow a less rigorous medical field than say sports medicine or cardiology? Probably not. Instead, Williams says, it "is often the quality of reporting of dermatology studies that is often lacking rather than the research itself."

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