Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adolescents and adults (aged 12-35 years) with moderate to severe facial acne
Intervention: Oral isotretinoin ᵃ
Comparison: Oral antibiotics plus topical agents ᵇ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Improvement in acne severity (follow‐up: 20-24 weeks): number of lesions | No statistically significant difference | Very Low |
Improvement in acne severity (follow‐up: 20-24 weeks): physician’s global evaluation | Favors intervention | Low |
Quality of life (Dermatology Life Quality Index; final scores) | No statistically significant difference | Very Low |
Dropout rates due to adverse effects | No statistically significant difference | Very Low |
Serious adverse effects (follow‐up: 20-24 weeks) ᶜ | No statistically significant difference | Very Low |
Adverse effects (follow‐up: 4-20 weeks) | Occurs more commonly with oral isotretinoin compared with oral antibiotics plus topical agents (favors comparison) | Low |
Note The authors of the Cochrane review which underpins this Cochrane Clinical Answer (CCA) noted that the review supports clinical guidelines that recommend isotretinoin as first-line treatment for people with moderate to severe acne, due to the improvement in acne severity as assessed by physician’s global evaluation. However, they stressed that there is uncertainty due to the low to very low quality of the evidence. ᵃ Isotretinoin was evaluated at any dose, course duration, or follow-up time. ᵇ In the included studies oral antibiotics were minocycline, tetracycline, or doxycycline and topical agents were adapalene gel, azelaic acid cream, and adapalene/benzoyl peroxide gel. ᶜ One serious adverse effect was reported in the isotretinoin group (Stevens‐Johnson syndrome).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does topical benzoyl peroxide monotherapy or add‐on therapy compare with placebo for people with acne?
- For young people with acne, how does oral isotretinoin compare with an antibiotic/topical agent combination?
- How do different interventions compare for people with acne scars?
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