Clicking through a popular acne forum reveals more than 15,000 threads on over-the-counter acne treatments and nearly 50,000 on prescription options alone, with people seeking tips on which treatments work best and how to use them. According to a new report, such discussions could speak to a broader issue: We still may not understand how effective the most widely used treatments are at combatting the common skin issue.
And it is common.
Researchers writing in the journal Lancet explain that almost everyone between the ages of 15 and 17 is affected by some degree of acne. They also highlight recent studies suggesting that more than 60 percent of twenty-somethings and 40 percent of adults in their thirties have regular, visible pimples.
The problem, the authors claim, is that a lack of head-to-head, comparative effectiveness research on the various treatment options -- including topical prescriptions, oral antibiotics, contraceptives and even natural options, like tea tree oil -- is still limited.
“The large number of products and product combinations and the scarcity of comparative studies has led to disparate guidelines with few recommendations being evidence-based,” lead author Hywel Williams, Ph.D., from the UK's University of Nottingham, said in a statement. Which means that many treatment guidelines are based on clinical expertise rather than high-quality comparative studies, and there is little data on whether prolonged use of antibiotics leads to bacterial resistance.
According to the report's authors, even the role face washing plays is still uncertain, as antibacterial skin cleansers could help with mild acne, but they provide little benefit to patients who are already on topical treatments that could cause irritation. They caution that excessive washing could prompt increased oil production.
Another gray area? What the authors call the "possible association between acne and diet," which they say continues to be "uncertain."
Some outside experts caution, however, that all of this seeming uncertainty should not prompt people to lose confidence in acne treatment altogether.
"Dermatologists know how to treat acne and we have effective treatments for acne," said Dr. Joshua Zeichner, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York. "Basically what this paper is saying is that a lot of the guidelines we have in treating acne are pooled from expert opinions, not head-to-head studies. But as a field you grow and learn every day."
In the meantime, he said people's best bet is still to seek treatment.
"Acne can have a significant psychological impact," Zeichner said. "If patients have acne, they need to see a dermatologist. [This paper] doesn't mean we don't have good treatments right now."