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Evidence-Based Practice
Acne vulgaris (acne) is the most common cutaneous skin disorder in the United States and affects as many as 17 million individuals. Approximately 85% of adolescents and young adults, ages 12 to 25 years, develop acne (Bergfeld, 1995). As a result, pediatric health care providers should be knowledgeable about the effectiveness of various treatments and provide accurate information, management, and guidance to teens and their families about this prevalent problem.
Acne results from a combination of abnormal and excessive sebum production from the sebaceous glands, a bacterium called Proprionibacterium acnes (P acnes), and other abnormalities of the skin that lead to the blockage of the pilosebaceous openings (Jordan, Cummins, Burls, & Seukeran, 2000). Non-inflamed lesions or comedones, inflamed lesions, and/or scars characterize acne occurring on the face, chest, shoulders, or upper arms. Blackheads and whiteheads are examples of non-inflamed acne. Papules, pustules, nodules, and cysts are examples of inflamed lesions.
In addition to the damaging effects on the skin, acne can have adverse psychosocial and emotional effects on an adolescent's life. Although treatment may be difficult, especially when delayed, acne can be effectively treated in primary care practice. Early and effective treatment of acne diminishes the need for specialty referral and the likelihood of permanent scarring.
Clinical Question
What are the most effective oral antibiotics and topical retinoid therapy for acne in adolescents?
Using the OVID system, the search for information first began on the Cochrane Database of Systematic Reviews, followed by CINAHL and MEDLINE for additional studies. The search was limited to the last 4 years and used combined sets of text words, such as acne vulgaris, study, antibiotic treatments, topical treatments, and adolescents.
The Evidence
Study # 1. Since it is often prescribed as a first- line antibiotic in the treatment of inflammatory acne, Garner, Eady, Popescu, Newton, and Li Wan Po (2000) conducted a metaanalysis to evaluate the clinical efficacy of minocycline in the treatment of inflammatory acne in comparison to other treatments.
Randomized controlled trials (RCTs) of minocycline for acne treatment were identified by Garner and colleagues searching the following electronic databases: MEDLINE, EMBASE, Biosis, Biological Abstracts, International Pharmaceutical Abstracts, Cochrane Skin Group's Trial register, Theses online, BIDS ISI Science Citation Index, and BIDS Index to Scientific and Technical...