Cochrane · systematic review · CD011368
Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acne
Liu, H, Yu, H, Xia, J, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
40
current version
GRADE rated
27
No studies
13
Included studies
NR
No studies 13 · 32.5%Ungraded 0 · 0%Very low 12 · 30%Low 13 · 32.5%Moderate 2 · 5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Azelaic acid compared to adapalene
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Improved to very much improved(long term: treatment duration > 8 weeks) Azelaic acid vs adapalene | RR 0.89 [0.68, 1.17] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Azelaic acid vs adapalene | RR 2.64 [0.33, 20.99] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (medium term: treatment duration from 5 to 8 weeks) Azelaic acid vs adapalene | RR 1.16 [0.47, 2.85] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Dermatology Life Quality Index (long term: treatment duration > 8 weeks) Azelaic acid vs adapalene | no estimate extracted | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Azelaic acid compared to benzoyl peroxide
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Good or very good improvement (long term: treatment duration > 8 weeks) Azelaic acid vs benzoyl peroxide | RR 0.82 [0.72, 0.95] | 1 study · 351 participants | Moderate Downgraded: risk of bias, imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Azelaic acid vs benzoyl peroxide | RR 0.88 [0.6, 1.29] | 1 study · 351 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (short term: treatment duration ≤ 4 weeks) Azelaic acid vs benzoyl peroxide | RR 0.5 [0.05, 4.94] | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Azelaic acid vs benzoyl peroxide | no estimate extracted | NR | No studies |
Azelaic acid compared to clindamycin
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Good or very good improvement (long term: treatment duration > 8 weeks) Azelaic acid vs clindamycin | RR 1.13 [0.92, 1.38] | 1 study · 229 participants | Low Downgraded: risk of bias, imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Azelaic acid vs clindamycin | RR 1.3 [0.48, 3.56] | 2 studies · 329 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (long term: treatment duration > 8 weeks) Azelaic acid vs clindamycin | RR 1.5 [0.67, 3.35] | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Azelaic acid vs clindamycin | no estimate extracted | NR | No studies |
Azelaic acid compared to tretinoin
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Good to excellent improvement (long term: treatment duration > 8 weeks) Azelaic acid vs tretinoin | RR 0.94 [0.78, 1.14] | 1 study · 289 participants | Moderate Downgraded: risk of bias, imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Azelaic acid vs tretinoin | RR 0.66 [0.29, 1.47] | 2 studies · 309 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event Azelaic acid vs tretinoin | no estimate extracted | NR | No studies |
Quality of life Azelaic acid vs tretinoin | no estimate extracted | NR | No studies |
Salicylic acid compared to benzoyl peroxide
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Salicylic acid vs benzoyl peroxide | no estimate extracted | NR | No studies |
Withdrawal for any reason (medium term: treatment duration from 5 to 8 weeks) Salicylic acid vs benzoyl peroxide | no estimate extracted | 1 study · 41 participants | Very low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (medium term: treatment duration from 5 to 8 weeks) Salicylic acid vs benzoyl peroxide | RR 0.21 [0.01, 4.11] | 1 study · 41 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life ARQL (medium term: treatment duration from 5 to 8 weeks) Salicylic acid vs benzoyl peroxide | no estimate extracted | 1 study · 41 participants | Very low Downgraded: risk of bias, imprecision |
Salicylic acid compared to pyruvic acid
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Good to excellent improvement (medium term: treatment duration from 5 to 8 weeks) Salicylic acid vs pyruvic acid | RR 1.12 [0.68, 1.84] | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision |
Withdrawal for any reason (medium term: treatment duration from 5 to 8 weeks) Salicylic acid vs pyruvic acid | RR 0.89 [0.53, 1.5] | 1 study · 86 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event Salicylic acid vs pyruvic acid | no estimate extracted | NR | No studies |
Quality of life Salicylic acid vs pyruvic acid | no estimate extracted | NR | No studies |
Salicylic acid compared to tretinoin
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Moderate to excellent improvement (long term: treatment duration > 8 weeks) Salicylic acid vs tretinoin | RR 1 [0.92, 1.09] | 1 study · 46 participants | Low Downgraded: risk of bias, imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Salicylic acid vs tretinoin | no estimate extracted | 2 studies · 74 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (long term: treatment duration > 8 weeks) Salicylic acid vs tretinoin | RR 1.37 [0.66, 2.87] | 2 studies · 74 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life AQOL (long term: treatment duration > 8 weeks) Salicylic acid vs tretinoin | no estimate extracted | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Nicotinamide compared to clindamycin
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Nicotinamide vs clindamycin | no estimate extracted | NR | No studies |
Withdrawal for any reason (medium term: treatment duration from 5 to 8 weeks) Nicotinamide vs clindamycin | RR 1.12 [0.49, 2.6] | 3 studies · 216 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (medium term: treatment duration from 5 to 8 weeks) Nicotinamide vs clindamycin | RR 1.2 [0.73, 1.99] | 3 studies · 216 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Nicotinamide vs clindamycin | no estimate extracted | NR | No studies |
Nicotinamide compared to erythromycin
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Nicotinamide vs erythromycin | no estimate extracted | NR | No studies |
Withdrawal for any reason (medium term: treatment duration from 5 to 8 weeks) Nicotinamide vs erythromycin | RR 1.4 [0.46, 4.22] | 1 study · 158 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event Nicotinamide vs erythromycin | no estimate extracted | NR | No studies |
Quality of life Nicotinamide vs erythromycin | no estimate extracted | NR | No studies |
Glycolic acid (alpha‐hydroxy acid) compared to salicylic‐mandelic acid
Population: participants with acne
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants' global self‐assessment of acne improvement Fair to good improvement (long term: treatment duration > 8 weeks) Glycolic acid (alpha‐hydroxy acid) vs salicylic‐mandelic acid | RR 1.06 [0.88, 1.26] | 1 study · 40 participants | Low Downgraded: imprecision |
Withdrawal for any reason (long term: treatment duration > 8 weeks) Glycolic acid (alpha‐hydroxy acid) vs salicylic‐mandelic acid | no estimate extracted | 2 studies · 84 participants | Low Downgraded: risk of bias, imprecision |
Total number of participants who experienced at least one minor adverse event (long term: treatment duration > 8 weeks) Glycolic acid (alpha‐hydroxy acid) vs salicylic‐mandelic acid | RR 1.8 [0.72, 4.52] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Glycolic acid (alpha‐hydroxy acid) vs salicylic‐mandelic acid | no estimate extracted | NR | No studies |