FINAL Management options for mild to moderate acne – pairwise comparisons

Forest plots for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? This section includes forest plots only for outcomes that are meta-analysed. Outcomes from single studies are not presented here; the quality assessment for such outcomes is provided in the GRADE profiles in appendix F.

Topical non-retinoids and retinoids

Figure 2: Comparison of topical retinoid treatments with vehicle for the outcome of skin irritation

ADAP: adapalene; ISO: isotretinoin; TRET: tretinoin

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 155 FINAL Management options for mild to moderate acne – pairwise comparisons

Figure 3: Comparison of topical retinoid treatments with topical benzoyl peroxide treatment for the outcome of skin irritation

ADAP: adapalene; BPO: benzoyl peroxide; ISO: isotretinoin

Figure 4: Comparison of topical adapalene treatment with topical tretinoin treatment for the outcome of skin irritation

ADAP: adapalene; TRET: tretinoin

Figure 5: Comparison of topical adapalene treatment with topical clindamycin and benzoyl peroxide treatment for the outcome of skin irritation

ADAP: adapalene; BPO: benzoyl peroxide; CLIN: clindamycin

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 156 FINAL Management options for mild to moderate acne – pairwise comparisons

Figure 6: Comparison of topical retinoid treatment in combination with topical antibiotics with topical benzoyl peroxide treatment in combination with topical antibiotics for the outcome of skin irritation

ADAP: adapalene; BPO: benzoyl peroxide; CLIN: clindamycin; ERYTH: erythromycin; ISO: isotretinoin

Figure 7: Comparison of topical lower dose retinoid treatment with topical higher dose retinoid treatment for the outcome of skin irritation

ADAP: adapalene; ISO: isotretinoin; TRET: tretinoin

Own class topicals

Figure 8: Comparison of topical azelaic acid with vehicle for the outcome of skin irritation

AZE: azelaic acid

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 157 FINAL Management options for mild to moderate acne – pairwise comparisons

Topical antibiotics

Figure 9: Comparison of topical clindamycin with vehicle for the outcome of skin irritation

CLIND: clindamycin

Figure 10: Comparison of topical dapsone with vehicle for the outcome of skin irritation

DAPS: dapsone

Figure 11: Comparison of topical antibiotic with topical antibiotic for the outcome of skin irritation

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 158 FINAL Management options for mild to moderate acne – pairwise comparisons

Figure 12: Comparison of topical antibiotic with topical antibiotic for the outcome of skin irritation

AZE: azelaic acid; CLIND: clindamycin; ERYTH: erythromycin

Topical antiseptics

Figure 13: Comparison of topical benzoyl peroxide treatment with vehicle for the outcome of skin irritation

BPO: benzoyl peroxide

Topical acids No meta-analysis was conducted for topical acid treatments and so there are no forest plots.

Oral antibiotics and combinations with other topicals No meta-analysis was conducted for oral antibiotic treatments and so there are no forest plots.

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 159 FINAL Management options for mild to moderate acne – pairwise comparisons

Oral hormonal contraceptives or hormone-modifying agents

Figure 14: Comparison of combined oral contraceptive treatment with placebo for the outcome of neurological side effect

EE-oral + DROS-oral: ethhinylestradiol + drospirenone; EE-oral + DNG-oral: estradiol (valerate) + dienogest

Figure 15: Comparison of combined oral contraceptive treatment with placebo for the outcome of breakthrough bleeding

EE-oral + DROS-oral: ethhinylestradiol + drospirenone; EE-oral + LNG-oral: ethhinylestradiol + levonorgestrel

Oral isotretinoin No meta-analysis was conducted for treatment with oral isotretinoin and so there are no forest plots.

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 160 FINAL Management options for mild to moderate acne – pairwise comparisons

Physical treatments

Chemical peels

Figure 16: Comparison of salicylic acid peel treatment with Jessner’s peel treatment for the outcome of skin redness

SAL: salicylic acid

Energy based treatments (light/laser) No meta-analysis was conducted for energy based treatments and so there are no forest plots.

Acne vulgaris: evidence reviews for management options for mild to moderate acne – pairwise comparisons FINAL (June 2021) 161