Acne treatment guidelines: Are they a CUT (Clear Unbiased Trustworthy) above the rest?




Poster session 2 Thursday: Evidence synthesis - methods / improving conduct and reporting


Thursday 14 September 2017 - 12:30 to 14:00


All authors in correct order:

Alison L1, Eady A1, Sprakel J2, van Zuuren E3, Arents B4, Fedorowicz Z5
1 Department of Dermatology, Harrogate and District NHS Foundation Trust, United Kingdom
2 Bahrain Breast Cancer Society, Bahrain
3 Department of Dermatology, Leiden University Medical Center Leiden, The Netherlands
4 Dutch Association for People with Atopic Dermatitis, The Netherlands
5 Cochrane Bahrain, Bahrain
Presenting author and contact person

Presenting author:

Julie Sprakel

Contact person:

Abstract text
Background: Acne, a chronic inflammatory skin condition, is the eighth most prevalent disease globally. Acne is treated by a wide range of care deliverers in a variety of settings. Given the large number of treatments available, there is a need for clear, unbiased, trustworthy (CUT) guidelines.

Objectives: To assess how many recently published acne treatment guidelines were developed using the AGREE II Instrument and to evaluate the effect on reporting quality using the AGREE Checklist.

Methods: Searches included Medline and Embase (01/2013 - 12/2016) and web-based guideline depositories. Six assessors, including 1 patient, with expertise in dermatology and/or critical appraisal scored the guidelines independently using the AGREE Reporting Checklist 2016. Discrepancies between scores of ≥3 were resolved through discussion or, where necessary, re-evaluation.

Results: Searches retrieved 274 articles identifying 8 treatment guidelines including 1 in Chinese translated prior to assessment. Only 2/8 used AGREE II in the development process; 1/8 rated the quality of evidence using validated methods; 5/8 took harms into consideration when formulating recommendations; 1/8 included a patient representative; 2/8 had external peer-review; 4/8 provided incomplete plans for updating; and, 6/8 provided disclosures (sometimes ambiguous) of competing interests. Five stated they were evidence-based. Four conducted a systematic literature review. Stakeholder representation on the development group was poor in 7/8 (1 not disclosed) with a preponderance of dermatologists. Five were funded by the pharmaceutical industry. Use of AGREE II during guideline development did not have the expected level of impact on quality ratings.

Conclusions: Acne treatment guidelines demonstrated variable reporting quality. Only 4/8 fulfilled the US Institute of Medicine definition of a clinical-practice guideline. Lack of methodological transparency, ambiguity, and freedom from potential bias challenge their trustworthiness highlighting the need for improvement. Resulting inconsistencies in recommendations may unintentionally divert the provision of optimal health outcomes.