[Research] Evidence Based Skin Care – An Unpopular Post

Beauty Tips For Body Care
I recently began researching some skin care products and used this subreddit for advice as well as some youtube dermatologists. What struck me as a health profession and now med student was that in both cases a lot of the products recommended have very very poor medical evidence.In medicine, evidence of efficacy (effectiveness of something) is ranked from 1 – 7 at the top of this table isclinical guidelines from an authority body e.g. American dermatology societysystematic review and meta-analysis (combined results of RCT’s and cohorts/case control studies)RCT (highest level interventional study)Cohort studiesCase control studiesDermatological agents are largely creams and gels or tablets and the conditions they treat are rarely life threatening. This makes them perfect and easy candidate for testing in RCT studies, the highest level of interventional study possible in which both the doctor and patient don’t know if what they’re receiving/giving is real or placebo.Despite this, rarely are skin care products tested in this way. Why? Well my guess is simply because they are largely funded by cosmetic companies trying to make money and don’t have to be given strict FDA approval for use as a medicine as say heart medicine would be.I thought I would put together a list of Cochrane systematic reviews (a not for profit organisation which uses a strict criterion for assessing medical studies) on a range of skin care topics discussed here.Topical benzoyl peroxide for acne Main findings: Current evidence suggests that BPO as monotherapy or add‐on treatment may be more effective than placebo or no treatment for improving acne, and there may be little to no difference between BPO and either adapalene or clindamycin.Oral isotretinoin for acne Main findings: Evidence was low‐quality for most assessed outcomes. We did not find any clear evidence from RCTs that isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician‐assessed acne severity.Light therapies for acne Main findings: High‐quality evidence on the use of light therapies for people with acne is lacking. There is low certainty of the usefulness of MAL‐PDT (red light) or ALA‐PDT (blue light) as standard therapies for people with moderate to severe acne.Interventions for acne scars Main findings: There is a lack of high‐quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables. There is moderate‐quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long‐term effects, the longest follow‐up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works.Interventions for photo damaged skin Note: this study was retracted from the Cochrane society due to a lack of disclosure of author affiliations to commercial interestsMain findings: There is conclusive evidence that topical tretinoin improves the appearance of mild to moderate photodamage on the face and forearms, in the short‐term. However, erythema, scaling/dryness, burning/stinging and irritation may be experienced initially. There is limited evidence that tazarotene and isotretinoin benefit patients with moderate photodamage on the face: both are associated with skin irritation and erythema. The effectiveness of other interventions remains uncertain.In summary when looking at only good quality medical studies that you can be reasonably sure are removed on confounders, bias and the placebo effect there is very little evidence for many cosmetic agents.
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